One of the benefits of being in leadership is the opportunity to be exposed to the thought leaders in our field. This was never more evident than at a visit of Harvey Fineberg, MD, PhD, to the most recent AAPA Board of Directors meeting.
Dr. Fineberg is an internationally recognized expert on health care and serves as the president of the Institute of Medicine. He told us much of what we already suspect and know, which is that we spend significantly more per capita on health care in the United States than many countries do and we do significantly worse on many important measures of health performance. He stated, “The central and inescapable conclusion is that we're just not using our resources as effectively as many others have used them to attain health.”
How can this be in the greatest country on earth, with supposedly the greatest health care system of any industrialized country?
Part of the problem, according to Dr. Fineberg, centers on prevention. We are great in this nation on spending money in the last decade of life, dealing with the previous 6 decades of unhealthy lifestyle choices and experiences. We are abysmal at our prevention efforts, and we are paying the terrible price of that mismatch between resources and where we are spending our money in health care.
As long as we continue to ignore this reality, we will continue to do poorly in important measures of health in our society, such as life expectancy at birth, infant mortality, and other standard measures of survival and quality of health.
Dr. Fineberg had many good ideas on how to better reform the health care system to improve the real measures of performance. As for PAs, he stated that “Those professionals who will be able to deliver necessary care in a manner that is accepted and is affordable will be the winners in this next phase of US health care.” He continued, “If PAs as a community and as individuals can be positioned as part of the solution to this central dilemma of health care, then the future for the profession is going to be very bright.”
One of the most thought provoking statements for me as a surgical PA was his opinions regarding how to reform how we pay for health care. Our current system pays for procedures, tests, etc, and not outcomes. Dr. Fineberg felt that this is a major obstacle to fundamental change in the health care system and will inhibit meaningful reforms.
I can really relate to this as I think about the incentives the drive my workday, and that of others who work in procedure-intensive specialties. Reform in payment for health care delivery is something that has to be addressed at the most fundamental level. If it isn't, health care reform will never achieve the outcomes we desire as a society, and the cost of failure will consume our budgets to unsustainable levels in the very near future.
I knew much of what Dr. Fineberg said at a subconscious and intuitive level, but it was illuminating to hear such a cogent argument for change from such a leading, industry expert. A journey of a thousand miles begins with the first step, and it is incumbent on all of us to keep an open mind, if a healthy population is our goal.
We are living in very interesting times, and no matters what happens, we all need to be a part of positive change in the lives of those who rely on us for their health care.
Steve Hanson is immediate past president of the AAPA.