When it comes to fixing the Wisconsin health care system, the saying, "Physician, heal thyself," can be extended to refer to hospitals, insurers, employers, government, pharmaceutical companies and consumers.
All of us have played a role in making our health care system more expensive and less efficient than it should be, and it will take all of us to help to fix it.
Let’s examine the roles of each health care stakeholder and see how we all might do our part to make quality health care more affordable:
Consumers have an important part to play. Preventable diseases are a major contributor to health care costs. The total bill for delivering health care in our country would decline precipitously if more Americans adopted healthy eating habits and exercise regularly.
Many employers are also recognizing that having a healthy work force increases productivity and reduces employee turnover. If every employer, regardless of its level of employee health care coverage, committed to promoting healthy living and creating incentives for employees to live healthier lifestyles, health care costs would moderate and even decline.
I am not about to leave out my industry, health insurers. Insurers have developed extensive programs to mitigate costs that impact provider and facility costs, often putting them at odds with doctors and hospitals. Insurers should develop reimbursement strategies that facilitate cooperation, such as increasing reimbursements to higher-quality and higher-efficiency providers. Insurers must also become more user-friendly and earn the trust of other stakeholders in the health care system. For example, explanations of benefit statements are too often encrusted with legalese and fail to explain why a benefit decision was made. Clarity about reimbursement practices and benefit levels would go a long way toward managing the expectations of both consumers and providers.
Doctors and hospitals also play a critical role in improving the efficiency and affordability of our health care system. Market-based reforms such as physician ratings and reward systems for quality and efficiency will over time lead to a system of best practices that will improve care and increase efficiency.
Pharmaceutical companies could lower health care costs with one simple step: actively working to combat misinformation about generics. In most instances, generic medications are equivalent to the brand product and cost 60 to 80 percent less, yet drug company advertising influences consumers to view the generic as inferior and pressures employers to cover the higher-priced brand version.
The federal government, the largest payer of health care benefits in the country, has perhaps the largest role to play. By reducing provider and hospital reimbursements and reducing subsidies to the states in recent years, the government has engaged in cost shifting. This pressure can set off a "life or death" struggle with private insurers over reimbursement levels. The federal government should review the effect of its actions and take whatever steps necessary to ensure cost-shifting does not occur.
All stakeholders in the American health care system have the opportunity to contribute to real reform that leads to more affordable, high-quality health care for all Americans. It requires that we all give a little more of ourselves so that everyone benefits.
Dr. Bruce Weiss is the market medical director of UnitedHealthcare of Wisconsin.
