What will the US healthcare system look like in the future? Are we getting reform right and how, and more importantly when, will we know?
In the financial world a leading indicator has been described as a factor that can be observed and measured that predicts how the economy as a whole is going to change. The Conference Board looks at factors (referred to as “Global Business Cycle Indicators”) such as manufacturing orders, new building permits, unemployment, stock prices and others to predict the near-term future of the economy. Are there any such indicators for the healthcare reform movement? Possibly.
Maybe one can find a leading indicator of reform and improvement by looking first for a lagging indicator of what is wrong with the system. HCR believes that everything wrong with healthcare currently manifests as a brief and impersonal interaction between patient and physician. Physicians, lacking both the courage and energy to advocate for their patients and profession, have acquiesced to the external forces that now control the healthcare system. It is a system that has been recently driven by the non-providers whose only interest is a monthly P/L statement. They threaten providers with decreased salaries if productivity (read number of patients not quality of care) decreases. The administrators do not have the knowledge base to assess or improve quality. So they template everything. Oh they will talk about quality and the patient experience but they don’t have the knowledge to improve either and in reality their own survival is tied not to quality but to the bottom line. In the rare instance that an administrator talks quality it is disingenuous and futile. Administrators place no value on the intellectual and academic components of the profession of Medicine. They would prefer that physicians spend all of their time seeing as many patients as possible because they can measure and manage the number of visit. The value of reading and education not important even though they claim to be on a quality march. And they frown on physicians spending a minute more than the 10 minutes that they allocated on their template. Thus as the healthcare system deteriorated the length of time that physicians spent with patients diminished.
So maybe there is something to this. If the lagging indicator of everything wrong in healthcare is a short patient visit then maybe a leading indicator of improvement will be a prolonged and non-hurried patient visit. Oh, and also an exponential growth in unemployed healthcare administrators.