Scott MacStravic, PhD
I still vividly remember daily exposure to the “Make Love, Not War” mottoes of the 60s, even though I had been born too soon to join in the movement (having been in the army 1958-61 and married in 1963). On the other hand, making war has seen renewed popularity, with “wars” on poverty, drugs, terrorism, etc. accompanying actual military adventures.
War has become close to the normal situation for stakeholders in our ineptly named “healthcare system”, which is really a sickness care non-system, with participants more often at cross purposes than fighting a common enemy. Conflicts of interest seem far more common than cooperative or collaborative efforts among stakeholders.
Articles reflecting severe conflicts regularly appear. United Healthcare is suing HCA over “hardball negotiating tactics” and “anti-competitive behavior” in Denver. [C. Sisk “United HealthCare Sues HCA Over Tactics” Tennessean.com Sep 19, 2006.] Policyholders in California are suing insurers over being dropped from coverage. [L. Girion “Dropped by Insurers When Costs Rise” BaltimoreSun.com Sep 17, 2006.] Over-attentive families question physicians and nurses about their patients’ care. [D. Shaywitz “Overattentive Families May Be Underrated” New York Times Sep 19, 2006 (www.nytimes.com)]
Providers fight with each other over turf, from specialists arguing over who should perform procedures to hospitals fighting with ambulatory surgery centers. [“Ill. Surgery Center Accuse Hospital of Intimidation” www.ModernHealthcare.com Sep 18, 2006] Nurses strike against their hospital employers. [“N.J. University Hospital Nurses End Monthlong Strike” www.ModernHealthcare.com Sep 18, 2006]
But there is at least one domain in healthcare where “love” is both possible and sensible, unlike the sickness care domain where conflict seems inevitable. It is in proactive health management (PHM), encompassing the full range of efforts designed to reduce the incidence and prevalence of disease and injury, and to manage chronic conditions in order to reduce crises, complications and worsening thereof. In this domain, current adversaries could and should become collaborators rather than combatants.
Payers can get behind PHM, since it can significantly reduce the sickness care costs of insurers, and even more significantly reduce the overall labor costs of employers. Consumers can join in, since they benefit in a wide variety of ways from being healthier and avoiding sickness, though they may object to how much work they might have to do in the process. Providers are at least rhetorically committed to the health of their patients and communities, with primary physicians increasingly showing interest in promoting health vs. merely treating sickness.
With the exception of providers whose revenue is wholly or chiefly dependent on reactive sickness care, just about everyone can join in a “lovefest” based on improving the nation’s health – in fact the world’s health, since the conflicts present in the US exist in most other countries as well. And even providers can count on a continued, if perhaps not quite as large or growing as fast level of demand for reactive sickness care, since it will take years to feel the full effects of proactive health, even if it becomes widely adopted.
Primary physicians, and many specialists already engaged in management of chronic diseases can easily combine proactive health with reactive sickness care, and hospitals are already combining at least disease management and modest wellness efforts with their sickness care programs. Most physicians in solo or small practices would need the support of hospitals to engage successfully in a full range of proactive health, particularly disease management efforts. Reducing the rate of increase in sickness care demand and costs is probably the only way that the country will be able to afford paying enough for both to enable providers to maintain the quality of their sickness care.
It may take what has often been deemed a “paradigm shift”, a “tipping point” and “disruptive innovation” for providers to move, either gradually or totally toward proactive health care, but it is a move likely to be welcomed and supported by all other stakeholders. It is something that demonstrates more “love” for patients, since they would be far better off not becoming sick in the first place. And it may be the only way that providers can survive while delivering high-quality “healthcare” in the long run.
