Whose Law is it Anyway?
Great Britain and the National Health Service are having a rough week. A total overhaul of the “model” healthcare system with $30 billion in savings targets needed to keep the country from fiscal ruin were announced to a flurry of political wrangling. One paper called the US healthcare effort a “warm-up act” in comparison. Trying to keep up with all things healthcare, I read the summary of the new healthcare proposal for Great Britain, hoping to pull out a nugget or two on centralization of care or significant payment reform. What I found headlining the summary surprised me – “First, we will put patients at the heart of everything we do.”
Now, maybe I shouldn’t have been so surprised. Healthcare is, after all, supposed to be about the patients we care for. My curiosity piqued, I looked at our new law, the PATIENT protection and affordable care act to see how our focus on patients compared. The proposed law in Great Britain is very direct – “The Government’s ambition is to achieve healthcare outcomes that are among the best in the world. This can only be realized by involving patients fully in their own care.” They have dedicated the first section of their new law to ways for the patient to lead his or her own care and focus on shared decision making.
How did we tackle this? The words “patient decision” are used together a total of 25 times in our new law, 24 of which are contained in a single section outlining a demonstration project on the creation of patient aids to help patients make the “right decision” about their care. The words “shared decision” found a mere 13 times, 9 of which are in the same demonstration project mentioned above.
I’m not here to say the British have gotten it all right. I do believe however that there is a valuable lesson to be learned. Allowing patients to have a shared decision-making role can be uncomfortable for us in the industry for a myriad of reasons. But without it, will we really be able to make significant change in our system? More and more research has shown improvement in outcomes as well as cost savings by including patients more directly in their own clinical decisions. With the majority of our discussion focusing on the “affordable care” piece of the puzzle, we may all be better served by realigning our focus on the patient.
As a father of three teenage boys, my life is rarely dull. Their insights and slant on most things are generally entertaining to say the least. Last night as I was sitting at my dinner table, my 16 year old son caught my attention. “Dad, the folks who make video games have got it figured out. They are marketing geniuses. They must be rolling in money.” Curious, I asked what he meant. He went on to share with me that on his new gaming system, there was a small avatar that sat in the lower right hand corner of the screen. According to my son, this avatar had no purpose whatsoever. It was not part of the game. It didn’t even move. It just sat there and blinked. The gaming company, it seems, has developed a system of buying “points” as imaginary money and with this money you can customize and dress your avatar in any way you wish. My son, perplexed by this, said “Dad, why would anyone buy something that has absolutely no value?”
