Rethinking health care service delivery in significant ways is not likely to happen in health care "reform"

There are a few big issues in health care:

1. The health insurance system was originally set up to regularize income for hospitals. That's why it's hospital and catastrophic (crisis) care oriented;

2. as well as job-based rather than community based;

3. so it doesn't address very well wellness promotion, management of chronic diseases, and community-based service delivery, and the lack of "primary care physicians" for people who don't have health insurance.

It seems as if the focus on state-based universal health care programs is providing everyone with insurance, but not in refocusing on how care is delivered through re-thinking. See "Mass. Bill Requires Health Coverage" from the Post.

This pattern looks to be repeated by the Obama Administration. From the Bloomberg News article "Obama Sets ‘Make-or-Break’ Deadline on Health Care (Update1)":

Democrats, who control both the House and Senate, are considering proposals that would require employers to cover all full-time workers or pay a penalty to the government; create a “health exchange” to allow consumers to buy insurance at lower, group rates; set up a new government-run plan to cover some of the uninsured; and levy new taxes to pay for universal coverage.

By carving out of the current health care system a new level for wellness promotion, management of chronic diseases, and community-based service delivery, especially at hours outside of normal "office hours," it's possible to cut costs and improve outcomes.

This is something I've written about in the past, including:

-- Dispuptive innovation (once again)
-- Reengineering Government Services
-- How to Solve the Hospital Crisis
-- Health Planning vs. Hospital Planning redux
-- Muddled thinking by Steven Pearlstein (Post business columnist)
-- An opportunity for rethinking health and wellness care in the District of Columbia

For rethinking on how to create and deliver public services, see:

-- Social Marketing the Arlington (and Tower Hamlets and Baltimore) way

It's not like this idea of community-based wellness service delivery is original to me. Christopher Alexander discusses it in Pattern Language, which was first published in 1979.

---------------
A new study by the Medical University of South Carolina suggests that during the past 20 years, older and middle aged Americans are not eating as well nor exercising as much as they used to. See "The Age of Good Health? Healthy Lifestyles on Decline in U.S."

More than 25 percent of Americans between the ages of 40 and 74 said that they ate five servings or more of fruits and vegetables each day, down from 42 percent in 1988. At the same time only 43 percent said that they exercise at least 12 times a month, compared to 53 percent in 1988.

The impact of this shift: in 1988, 28 percent of Americans were classified as obese, compared to 36 percent in 2006.

Despite all the publicity about the dangers of smoking, 26 percent of Americans in this age range continue to use tobacco products – the same as 20 years ago.



Companies like McDonald's spend far more money in one month on often unhealthy messages than the health and wellness profession spends in an entire year on positive health messages.

The problem is far more wide ranging than the lack of health insurance.