Access to Healthcare: The Right of the People

Oct. 29, 2009
Editor’s Note: This is the fourth installment in our year-long 30th anniversary “Pioneers in Healthcare IT” celebration, featuring articles from past issues of Health Management Technology, formerly called Computers in Healthcare. This article appeared in the May 1990 issue. When this article was printed, David M. Pomerance was president of healthcare systems at Unisys, Charlotte, N.C.

The American healthcare system is based on the principle that healthcare is an inherent right of the people. The challenge we must meet as a nation is to provide access for all Americans to healthcare services that will improve the quality of life – at a price the country can afford.

This dilemma has forced many Americans to face difficult philosophical and ethical issues of access. With each advance in medical technology, the cost of sustaining life rises. Is everyone entitled to the ultimate in high-tech treatments, regardless of the cost and the anticipated outcome? We have to make some difficult choices. Changes in our attitude about the right to healthcare and changes in the healthcare system will be required.

Editor’s Note: This is the fourth installment in our year-long 30th anniversary “Pioneers in Healthcare IT” celebration, featuring articles from past issues of Health Management Technology, formerly called Computers in Healthcare. This article appeared in the May 1990 issue. When this article was printed, David M. Pomerance was president of healthcare systems at Unisys, Charlotte, N.C.

The American healthcare system is based on the principle that healthcare is an inherent right of the people. The challenge we must meet as a nation is to provide access for all Americans to healthcare services that will improve the quality of life – at a price the country can afford.

This dilemma has forced many Americans to face difficult philosophical and ethical issues of access. With each advance in medical technology, the cost of sustaining life rises. Is everyone entitled to the ultimate in high-tech treatments, regardless of the cost and the anticipated outcome? We have to make some difficult choices. Changes in our attitude about the right to healthcare and changes in the healthcare system will be required.

Government, employers and healthcare providers should work together to ensure minimum access for everyone – particularly for preventive care, as well as for diagnosis and management of chronic illness.

In the 1980s, we were not successful in containing healthcare costs or ensuring access. By 1989, healthcare expenditures were consuming more than 11 percent of the gross national product, up from 9.1 percent in 1980. Healthcare spending increases outpaced inflation by almost two to one. The diagnosis-related group (DRG) system, while containing Medicare inpatient costs, has not translated into controlled growth in healthcare expenditures. Instead, the private sector has been left to pay for uncompensated care, and 37 million uninsured Americans are denied access to essential healthcare services.

To meet this challenge, Americans should begin to see the healthcare system as a tool to prevent disease, as well as a tool to cure it. Citizens should take advantage of programs that teach how to stay healthy, provide preventive care and allow early diagnosis of chronic illness.

Government, employers and healthcare providers should work together to ensure minimum access for everyone – particularly for preventive care, as well as for diagnosis and management of chronic illness. Incentives for employees to take advantage of educational programs, preventive care and early diagnosis services, and to providers to expand these services, are critical.

Everyone will benefit in the long run because education and preventive care are less costly, not only in dollars but in human suffering. Efforts to substantiate effectiveness of care should increase. Healthcare providers should actively participate in research and standards development. The government and employers should focus on value, not just lowest cost.

Hospitals will play a key role in these changes, learning to work more collaboratively with physicians to manage for value and provide a continuum of care. Tools to help staff members increase productivity are essential. Most importantly, hospitals should focus on education, ambulatory and chronic-care services concentrated in the home and the community, becoming a broker for a wide range of healthcare services.

Just as DRGs have changed inpatient healthcare reimbursement, these changes have far-reaching implications. Just as information systems were crucial to a hospital’s ability to survive under DRGs, they will continue to increase in importance.

Information-systems support will be essential to capture data to support decisions about the most cost-effective treatments to produce appropriate outcomes, the type of services needed and where to find them. They can also free professionals from clerical tasks and provide more time for patient care. Like hospitals, they will evolve to support the continuum of care necessary in the 1990s.

The lesson of the 1980s was that cost, quality and access cannot be addressed independently to achieve goals. Everyone should work together to support the right of all Americans to maintain healthcare in the 1990s.

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