The best way to improve the effectiveness, while reducing the cost, of health care in the U.S. is to allow people to take a more activist approach to their family's health. That means giving the consumer of health care services the power to decide what is the most appropriate testing, prescription and solution to their health issues.
1. Moving the money-to-be-spent (of employer-paid annual health insurance) to the employee in a "Health Spending Account" (HSA) is the first step in the process of increasing health service providers efficiency. The Medicare Prescription Drug Improvement and Modernization Act of 2003 created Health Spending Accounts. A HSA is simply a tax exempt trust that allows employees and/or employers to save money to be used to pay for medical expenses that are not covered by a health insurance plan. The HSA must be paired with a high deductible health insurance plan.
These accounts differ from Flexible Spending Accounts in one important variable; they may accumulate funds over an extended period of time, and roll over the balance in the accounts from one year to the next. The accounts may also be rolled over from one employer to another, making them portable, like a 401(k) retirement plan. As long as the money is used to pay for medical expenses or health insurance premiums, the funds are tax exempt. The biggest advantage of the HSA is large premium savings for the employer and an opportunity for employees to accumulate tax exempt assets.
2. The second step is to share medical knowledge with people, through online Internet access to personal health records....enabling them to make smarter choices about their health habits and medical care.
Today, Microsoft's software animates more than 90 percent of all personal computers, while Google is the default starting point for most health searches. And people are increasingly turning to their computers and the Web for health information and advice. A Harris poll, published in July 2007, found that 52 percent of adults sometimes or frequently go to the Web for health information, up from 29 percent in 2001. The capability of the Web promises to accelerate a shift in power to consumers in health care, just as Internet technology has done in other industries.
Now, about 20 percent of the nation's patient population have computerized records--rather than paper ones. But these records still tend to be controlled by doctors, hospitals or insurers. A patient moves to another state, for example, but the record usually stays.
Electronic formatted patient records would give much more control to individuals, a trend many health experts see as inevitable. "Patients will ultimately be the stewards of their own information," said John D. Halamka, a doctor and the chief information officer of the Harvard Medical School.
Already the Web is allowing people to take a more activist approach to health. According to the Harris survey, 58 percent of people who look online for health information discussed what they found with their doctors in the last year. It is common these days, Dr. Halamka said, for a patient to come in carrying a pile of Web page printouts. "The doctor is becoming a knowledge navigator," he said. "In the future, health care will be a much more collaborative process between patients and doctors."
A Thorny Challenge
Personal health records promise to be a thorny challenge for practical and privacy reasons. To be most useful, a consumer-controlled record would include medical and treatment records from doctors, hospitals, insurers and laboratories. Under federal law, people can request and receive their personal health data within 90 days. But the process is complicated, and the replies typically come on paper, as photocopies or faxes.
The efficient way would be for that data to be sent over the Internet into a person's digital health record. But that would require partnerships and trust between health care providers and insurers and the digital record-keepers.
Source: The New York Times, August 14, 2007