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Weekly UpdatesAs discussed last month, the Alaska Health Strategies Planning Council is embarking on the formidable task of creating a comprehensive health care plan for Alaska by January 2008. The Alaska Health Care Roundtable identified certain priorities and the Council will undoubtedly be flooded with other ideas and suggestions. This second article suggests additional considerations to either be dealt with or improved.
CHALLENGES AND NEW INITIATIVES:
* Alaska has information gaps that need to be filled if we are to chart an optimum path to progress. Fundamental research to enable policy-makers to make sound decisions based on facts should continue. It is ironic to compare the amount of money and manpower that Alaska devotes to optimizing fish, game and natural resources, versus what we spend to understand our human health needs. Aren't we more valuable than salmon or moose?
** Quantify and identify the source of Alaska cost differentials versus Outside.
** Understand who is not covered or insufficiently covered.
** Continue to define work force development challenges across the full job spectrum.
** To help coordinate needed information, the University of Alaska Anchorage Institute of Social and Economic Research needs a qualified health care specialist to monitor and analyze Alaska health care economics.
* Electronic health records are the cornerstone of modernizing Alaska health care. No other major industry is as backward in its data processing. The Electronic Health Record Initiative has made substantial progress developing business plans to modernize health records.
* Develop navigation aids and fail-safe systems to help people gain access to and deal with complexities of the system. Many individuals are unable to access needed services on their own. Navigation aids must take into account the human, as well as technological networks, which build healthy lives.
* Continued increases in Medicaid and Medicare costs will necessitate additional matching state funds and overall growth in the state health care budget.
* Monitor and learn from other state's experiments in coverage and cost control.
* Keep track of the changing federal health care environment.
THE FEDERAL ENVIRONMENT
* In inflation-adjusted terms, most federal funding is flat or declining. Federal Medicare and Medicaid payments are not keeping up with the rising cost of providing service.
* Long-standing federal laws require the federal government to provide health care for Native Americans, including Native Alaskans. Recent Indian Health Service funding in Alaska has been increasing at about one-third the rate of increase in underlying care. The other two-thirds effectively become absorbed by cuts in service.
* President Bush proposed eliminating business deductions for employee health care coverage. It would be replaced by an individual tax deduction and subsidies for economically needy, which would be funded by additional tax collections from those with lavish health care plans. If approved, the president's plan would alter the relative merits of employer-sponsored health care, compared to other plans.
* National surveys show that health care is the No. 1 economic concern of Americans. Overall, only the war in Iraq is more pressing. With a Democratic Congress and an upcoming presidential election, congressional and presidential candidate health care proposals have already started to spill forth. Increasing pressure from businesses and coalitions will add to the stockpile of new national health care proposals.
Unfortunately, the largest perpetrator of this policy is the federal government.
* In the chart below, the horizontal line just above "Medicare" and "Medicaid" represents the actual cost of delivering health care services.
* Any payer below the line is not paying their cost of service. The two largest under-payers are Medicare and Medicaid. Uncompensated care, both charity and bad debt, also significant.
* Private payers are the only ones above the line. They are subsidizing the deficit left over by others. Health care providers must turn to private payers to keep their doors open and keep paying their bills.
Where can we get bang for the buck?
* The Health Services pyramid (next page) highlights the building blocks of an efficient, effective health care system.
* Services lower down the pyramid offer the greatest return for money invested in terms of health impact on the entire population because they focus on prevention.
* Avoiding, delaying and reducing disease results in big savings.
* Services higher up the pyramid become increasingly specialized and expensive.
* When we say that our system is "broken" or "backward" it is because a massive and disproportionate amount of resources are devoted to the top of the pyramid.
* The basic point is that broad population-based health services really pay off and need to be the base of an effective, efficient health care system.
* Of course, all layers of the pyramid are necessary. The trick is finding the right balance that will result in optimal health for Alaskans in the long run.
Technology has been the driving force behind both health care progress and rapidly escalating costs. These trends will accelerate in the future.
* In health care and medicine, as in war, technology sets its own pace. Once developed, everyone wants the latest procedures and equipment they can afford. The availability of insurance has facilitated the hugely expensive procedures referenced in the pyramid and chart above.
* Some form of electronic health records and the ability to access and connect them are inevitable. The only issue is how appropriate they will be to our needs as Alaskans. The Internet has enabled access to information to both the public and professionals that was previously unthinkable.
* Pharmaceuticals have been a major driver of progress and cost. This will accelerate as genetically designed drugs and procedures evolve into core prevention and treatment strategies. Genetic technology will create a new realm of ethical issues for society to understand.
Good things are happening that can be built upon:
Access:
** Anchorage Project Access has enrolled more than 70 percent of eligible doctors to coordinate charity medical care.
** Neighborhood Health Centers demonstrate their effectiveness and efficiency.
** Facility and service enhancements around Alaska are reducing the need to seek treatment Outside.
** A legislative proposal to double the number of state-supported medical students (WWAMI) appears favorable. However, much more work force recruitment and development is needed.
Quality:
** The successful national "100,000 Lives Campaign," to improve quality and safety of hospitals, has been expanded to 5 million lives. Local hospitals have active quality control programs.
** Progress in the Veteran's Administration System proves that focus and coordination can transform even huge organizations.
** The Alaska Native Tribal Health Consortium efficiently offers holistic health services to its clients.
Costs:
** The need for understandable medical bills is better recognized, if not yet implemented.
** Improved liability and tort laws help reduce malpractice insurance costs and make Alaska a more attractive place to practice medicine.
** More and better information on Alaska costs is becoming available and pointing out the need for additional research.
The Alaska Health Care Strategies Planning Council will need to address these needs:
* Education of Alaskans and finding ways to incentivize better individual health behavior. Fundamental responsibility for better health lies within each of us, but public health education will need to be a key part of building and reinforcing this awareness.
* Schools offer a natural health education opportunity, as well as foster healthy lifestyles with exercise in gym and athletics.
* Identification of current and future service gaps in personnel and facilities to prioritize investments and programs.
* Organization of work force development to attract, train and retain sufficient health care professionals of all types and for all parts of Alaska.
* Coordination of adequate facilities sufficient to serve Alaskans without having to leave the state for treatment.
* Creative development of sustainable funding sources adequate to improve the health of Alaskans.
Duane Heyman is executive director of the Alaska Health Care Roundtable. Previously he was executive director of Commonwealth North and editor of its health care study. His career includes executive positions in finance, real estate, retailing and nonprofit management. He and his wife, Carol, are civic and arts supporters. Heyman can be contacted at heyman@alaskaroundtable. org or 350-2934.
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