Beginning in the later part of 2008, Healthcare Information Services, a Missouri not-for-profit corporation, undertook a study to define the requirements needed to move the financial systems and economics of the current, money driven, politicized provision of healthcare in America to a system providing cost-effective, evidence based, quality healthcare. Joined in early 2009 by the cooperation of the St. Louis University School of Public Health, the entire spectrum of healthcare providers and affiliated administrative agencies, governmental to insurance companies, was queried and incorporated in the study. This paper is a summary of the conclusions and findings of that extensive and comprehensive study.
There are two distinct and self-defining groups to be addressed in any discussion of the provision of healthcare in America. Succinctly, these two groups are constituted by two populations – the insured and the uninsured. The public health issues concerning the actual provision and access to healthcare for either group are not a subject of this paper. Partly because of existing legislation, but mainly, and earlier, due to the ethical responses of some healthcare providers, medical care has always, to a varying degree, been available to all Americans. This study is applicable to all segments of the population focusing on providing cost-effective, evidence based, quality healthcare. As such, there is global relevance, crossing all political and economic boundaries.
Because, in America, approximately 70% of the costs for healthcare are paid for with taxpayer funds, federal agencies were included as part of the study. American workers, through payroll taxes, i.e. Social Security and Medicare, pay, and paid, in advance for their medical care in retirement. Those responsible for the remaining 30% of the healthcare dollar, the businesses representing the actively working American, were the most helpful and supportive of this study. CMS was interested in its own bureaucratic agenda, and less than helpful in this study. The Executive Office of the President was totally uncooperative. Responses from other politicians’ staffs was variable, and generally not helpful.
Any healthcare delivery system seeking cost-effective, evidence/outcomes based, quality healthcare demands, as its prime requisite, a queryable, statistical database capable of providing the information upon which such a system must be based. Secondly, that information must be totally, without exception, scientifically based, and completely free of political interference and corruption. Thirdly, such a queryable database must protect individual privacy, but, yet, allow the transmission of sufficient information as to enable free-enterprise, quality driven competition among all healthcare providers. And, fourthly, governments must mandate that all contributors to the costs, provision of, and administration of healthcare, input all information within their respective purviews to the database.
Technologically, the software and hardware necessary to establish a universal, healthcare information database are currently available. The problem, as it exists now in America, and globally, is there is no such database, and, worse, from this study, political and special interests are actively thwarting efforts to establish one. Much of the time and effort of this study was able to specifically identify those roadblocks and impediments. The remainder of this paper will address the challenges facing making a healthcare database enabling cost-effective, evidence/outcomes based, quality healthcare possible.
The second requisite above, statistical and actuarial validity, can be provided by an apolitical, publically accountable, panel of volunteer experts in relevant disciplines, such as medicine, actuarial science, public health, etc. having oversight of the database.
Privacy and patients’ rights concerns can be managed by technologies readily and currently available to IT professionals, directed by legislative oversight.
Problems in bringing constructive change to healthcare in America are highlighted by the third and fourth requisites that would establish the critical, indispensable source of information to birth a cost-effective, evidence/outcomes based, quality healthcare system. Here, the results of this study, obtained in, and relevant to Missouri, will be shared for specificity, but are obviously relevant and applicable in other jurisdictions.
Most significant is the erroneous perception, put forth by government itself, that government and its inefficient, demonstrably proven, failed bureaucracies, are an alternative to a free-enterprise, competitive system which has needed resources accessible to it, such as the database proposed would provide. Most certainly, legislatures could, and should, maintain oversight over the healthcare industry, much as they do, or suggest they do, over utilities and insurance companies.
Coupled with that politically motivated belief is the finding that the Missouri government, both legislative and executive branches, and the Federal government are unjustly influenced by the very special interests directly responsible for the out-of-control, money driven healthcare system shackling our nation. False information from lobbyists, money to political campaigns, political power alliances, etc. covertly and legally bribe public officials to tolerate the economic tragedy infecting the most scientifically advanced healthcare in the world.
Doctors are complicit in failing to protect the public health only by failing to organize themselves to meaningfully confront the takeover of the practice of medicine by corporations, hospitals, hospital systems, and governmental agencies. Taking over medicine, and the ones primarily responsible for the unjust costs of healthcare, are the various administrators, not providing any form of healthcare, and, in the private sector, parasitizing the efforts of true healthcare providers to pay their outlandish, unjustified salaries.
It is those administrators, who in this study, were most resistant to cooperating with the establishment of a mandatory, universal healthcare information database. Refusing cooperation was found to be just the tip of the conspiracy impacting the public health.
Apart from the direct lobbying and misinformation disseminated by these special interests uncovered in this study, other sites of unaddressed disease and infection were diagnosed. A former administrator of one of the large, excess cost generating hospital systems, alluded to above, is now head of Missouri’s Department of Social Services, appointed by the governor. Along with the Missouri Department of Health, the Department of Social Services is preemptively responsible for a Healthcare Information Exchange, among other government inspired initiatives, such as HHS’s Health Information Network, or MHI locally, hoping to short-circuit meaningful and valid efforts for an apolitical, healthcare information database, which would challenge their governmental bureaucracies. Missouri and other states have engaged a Washington, D.C., for-profit company, Minot, to further their efforts. At every level, those seeking unregulated, unjust profits multiply and escalate the costs of healthcare. Federal taxpayer monies have been allocated to Missouri to support the government agenda. Of all government entities, the VA, with its 5+ million patients is, and remains, the most cooperative and interested in bringing cost-effective, quality healthcare to those in its responsibility. In contrast, grants and funding to those seeking to develop a universal healthcare information database outside of government control have been denied. Any financial support for this needed public health initiative has come exclusively from businesses. Rendering impotent the unjust special interests and their unjust governmental influence is a necessary step in restoring accountability to the administration of the public health.
Another critical move in protecting the public health, in addition to legislatures mandating the healthcare database and requiring all providers to submit mandatory information to the database before any payments, would be the establishment of universal input portals to the database. Every provider – hospital, doctor, pharmacy, OT, PT, device provider, etc. would have an Internet, or other link to provide required input to the database. Payments, billings, etc. would be blocked until required information was submitted to the database. This software should be free to every provider, open source, and controlled by a publicly accountable, not-for-profit agency such as, or similar to, the one overseeing the database.
As it is now, doctors must pay one of many EMR vendors, again tapping medical providers held captive to the profit incentives, getting thousands of dollars per doctor, without any provision for uploading information to the database. Notice again that the shackles and costs attending EMRs are applied by government, further escalating the cost of healthcare in America. Pharmacists, therapists, medical laboratories, medical technicians, etc. are all trapped by the existing system and its purveyors. Need the rhetorical question, “Who ultimately pays these costs?”, be asked?
It is time for healthcare professionals to reclaim responsibility for the public health from the politicians, the bureaucrats, and uncontrolled industry profiteers. The conclusion of this extensive, comprehensive study is that a queryable, universal, healthcare information database, in public, non-governmental control, enabling cost accounting, outcomes and effectiveness studies, quality control, cost tracking, accountability, etc., and transparency in all these areas, is but the necessary, but yet absent, first step. The call is to those we elect to represent us in government to establish justice, and free us as we pursue our health.
Acknowledgments: St. Louis University School of Public Health
St. Louis Area Business Health Coalition – Louise Y. Probst, R.N., M.P.H.