Wednesday, April 9, 2008

Healthcare Outcomes

There is a constant demand for more and more spending on healthcare, but how are we measuring if the money is well spent? What is the bar we set for the healthcare system? I look at our healthcare system and I can not see anyone looking at the fundamentally most important outcome - are we healthier?

There is a constantly increasing demand for more healthcare in out society, but as far as I can see there is no indication that all this spending is making us any healthier than we were thirty to fifty years ago. We have a lot more diagnostic tools available and their use costs a fortune, is it helping use at all? As an example, ultrasounds for pregnancy are expected and often there are numerous ones during a pregnancy. It is almost as if the doctors have lost their faith in their own ability to judge how a pregnancy is going and where it is at. The new tools are there and the system uses them. This pattern repeats over and over again.

I know what my major healthcare problem is - I have gained weight and I am not in shape. If I do not take action on this I will shorten my life and I will reduce the quality of it as my joints in my legs give out and sleep gets worse. I will become a burden on the system because I did not take care of myself. My issue is the same sort of one for a lot of people, the biggest healthcare problems we have we have inflicted on ourselves by lifestyle. As a nation we are less healthy than people were 30 years ago and it is our own damned fault.

Meanwhile we have built a healthcare system that enables us to lead a bad lifestyle. In fact we have created a system that makes the providers wealthier because we do less to look after ourselves. Why do we not hold our GPs responsible for the health of their patients? Why do we not build in personal responsibility into our healthcare system? By being overweight (again) I am dramatically increasing the odds of getting hypertension and diabetes - if this happens it is my fault and no one else's, why should the healthcare system pay for my problems?

What we might look at is some sort of system of higher fees for people that have health problems they have caused. Or we set up a system of rewards for looking after yourself. In some way the government needs to have the system penalize or reward people financially for their behaviour. The biggest way to motivate people to act in responsible manner for anything longer term is to have real costs applied to it. If you smoke or are overweight, increase your MSP premiums. Allow people to pay lower MSP premiums if they can prove exercise 4-6 times a week. This sort of approach will go further than others because the financial bottom line is the single best motivator.

The reality is that we know what we should be doing for long term good health, the problem is the short term access to that chocolate cake and the TV. The RIGHT NOW pushes away the future needs very easily, but if there is a significant financial penalty to the right now, it becomes easier to change habits.

We then need to deal with the enablers in the healthcare system. The fundamental problem here is that the system is set up to solve your immediate health problems, the RIGHT NOW, and not to focus on the big long term picture of your health and staying healthy in the first place. There is no one out there that you can see that has the task to work with you to keep you fit and healthy and thereby avoid future problems. Out gatekeepers are the GPs who you see when you have a specific problem and are not there to deal with your bigger picture when you come in for your ten minute appointment. The very approach to health needs to change, we need to develop a practitioner who has the role in our life to guide you in a health lifestyle.
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