Discussions about U.S. health-care reform have largely focused on broadening insurance coverage. That's unfortunate, says a Stanford researcher, because we should spend more time looking for ways to truly improve health.
Randall Stafford, MD, PhD, professor of medicine at the Stanford Prevention Research Center, says the health-care system needs to be re-engineered to help people stave off conditions like obesity and diabetes in the first place.
"Increasing health-care coverage has the potential to make the inefficiencies of the current system more visible and worsen the current financial stresses in the system," Stafford says. "We need to think about more fundamental changes in the way that health care is delivered."
Stafford lays out his position in this perspective piece published in the Sept. 6 issue of the New England Journal of Medicine. He and co-author, Farshad Marvasti, MD, MPH, an adjunct clinical instructor of medicine, write that although policy-makers have highlighted the need to develop better methods of preventing disease, "efforts to expand prevention continue to be thwarted by a system better suited to acute care."
They point out that the current model for medical care arose 100 years ago when people didn't live as long and infectious diseases caused large numbers of deaths. Laboratory research helped develop treatments and technologies to combat these diseases, and a payment structure evolved that compensated doctors for prescribing pills and procedures to treat the conditions.
But the picture has changed drastically today. More Americans are living longer and are dealing with the results of progressive, chronic diseases brought on by factors such as smoking and obesity. Yet the health-care payment structure hasn't adapted. Strategies for preventing disease -- such as coaching patients on how to make meaningful changes that will enhance their health -- may be cost-effective, but they can't be patented or made profitable, which gives researchers little incentive to explore the field, the authors write.
And the way doctors are trained must change as well, Stafford and Marvasti write. Medical students should be taught disease-prevention strategies, and residencies in primary care should be shifted away from hospitals (where acutely ill patients are treated) into alternative settings, such as "medical homes" where a full team of health-care professionals work with patients and their family members to get the care they need at the appropriate time.
These kinds of wholesale changes to encourage disease prevention are "the only way to thwart the emerging pandemic of chronic disease," they write.
Previously: Does the Affordable Health Care Act address our health-cost problem?, Physician organizations offer free curriculum to educate medical students on reducing health costs
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