Comments on: U.S. HEALTH CARE: International Scholars Experience Our System — What They Would Change http://healthaffairs.org/blog/2007/10/17/us-health-care-international-scholars-experience-our-system-what-they-would-change/ The Policy Journal of the Health Sphere Fri, 20 Nov 2009 20:04:42 -0500 hourly 1 By: kcouturier http://healthaffairs.org/blog/2007/10/17/us-health-care-international-scholars-experience-our-system-what-they-would-change/comment-page-1/#comment-11980 kcouturier Sat, 24 Nov 2007 18:57:37 +0000 http://healthaffairs.org/blog/2007/10/17/us-health-care-international-scholars-experience-our-system-what-they-would-change/#comment-11980 Thank you for this unique view on the idiosyncrasies of the US health care system. It is always striking how choice, even superficial or poor choice, so often trumps access or quality. Despite the quantity of data indicating that other countries consistently achieve both greater health outcomes and better patient satisfaction with less money than the US system, American consumers consistently balk at proposals to limit consumer “choice.” Ironically, and as your fellows pointed out, the so-called choice provided in today’s system, is often more restrictive due to prohibitive cost and coverage options. Moreover, for the growing population of uninsured and underinsured Americans, the choice often boils down to going with and going without treatment at all. Any attempt at reform will, as you have stated, have to pay “lip service” to notions of consumer choice. However, in my opinion, reform will also have to attempt to shift focus away from such measures, and remind people that issues of access and outcome are equally, if not more important. I also appreciated your discussion of self-directed healthcare. Health care and health services are, by nature of their complexity, areas where the majority of consumers lack the knowledge to make a fully informed choice. Clearly, counseling from a trusted expert can be highly beneficial to those with the time to spare and the awareness of this option. I am curious, however whether you and the researchers believe that this is a sustainable and affordable approach to meet the needs of all Americans. I worry that, on scale-up, this approach would prove unmanageable. I wonder what other solutions you came across that help consumers get the most of our current system and that could work on a larger scale. Thank you again for this very interesting post. Thank you for this unique view on the idiosyncrasies of the US health care system. It is always striking how choice, even superficial or poor choice, so often trumps access or quality. Despite the quantity of data indicating that other countries consistently achieve both greater health outcomes and better patient satisfaction with less money than the US system, American consumers consistently balk at proposals to limit consumer “choice.” Ironically, and as your fellows pointed out, the so-called choice provided in today’s system, is often more restrictive due to prohibitive cost and coverage options. Moreover, for the growing population of uninsured and underinsured Americans, the choice often boils down to going with and going without treatment at all. Any attempt at reform will, as you have stated, have to pay “lip service” to notions of consumer choice. However, in my opinion, reform will also have to attempt to shift focus away from such measures, and remind people that issues of access and outcome are equally, if not more important.

I also appreciated your discussion of self-directed healthcare. Health care and health services are, by nature of their complexity, areas where the majority of consumers lack the knowledge to make a fully informed choice. Clearly, counseling from a trusted expert can be highly beneficial to those with the time to spare and the awareness of this option. I am curious, however whether you and the researchers believe that this is a sustainable and affordable approach to meet the needs of all Americans. I worry that, on scale-up, this approach would prove unmanageable. I wonder what other solutions you came across that help consumers get the most of our current system and that could work on a larger scale.

Thank you again for this very interesting post.

]]> By: acavale http://healthaffairs.org/blog/2007/10/17/us-health-care-international-scholars-experience-our-system-what-they-would-change/comment-page-1/#comment-11519 acavale Thu, 15 Nov 2007 01:04:31 +0000 http://healthaffairs.org/blog/2007/10/17/us-health-care-international-scholars-experience-our-system-what-they-would-change/#comment-11519 Excellent summary of the current situation in US health care. Vidhya Alakeson's observations are quite in line with our own experience while trying to help our Medicare D patients negotiate the maze of plans/choices. While individual choices is paramount to the American consumer (whether its health care or other service) we agree that choices made by fully enlightened and empowered consumer are vastly superior to what most Medicare bneficiaries are currently making. In our own practice, we see some beneficiaries getting great benefits from an educated selection, while others suffer at the whims of their plans (possibly selected based on media and other reports). I also agree that current reporting of physician "performance" is not only irrelevent but is a farce and does not benefit the consumer in any tangible manner. It is a pity that an outsider has to point these things out (obvious to any keen observer) when we have thousands of policy wonks right in our midst. Good work by these Fellows. Excellent summary of the current situation in US health care. Vidhya Alakeson’s observations are quite in line with our own experience while trying to help our Medicare D patients negotiate the maze of plans/choices. While individual choices is paramount to the American consumer (whether its health care or other service) we agree that choices made by fully enlightened and empowered consumer are vastly superior to what most Medicare bneficiaries are currently making. In our own practice, we see some beneficiaries getting great benefits from an educated selection, while others suffer at the whims of their plans (possibly selected based on media and other reports).
I also agree that current reporting of physician “performance” is not only irrelevent but is a farce and does not benefit the consumer in any tangible manner. It is a pity that an outsider has to point these things out (obvious to any keen observer) when we have thousands of policy wonks right in our midst. Good work by these Fellows.

]]> By: What are we really fighting for… access or choice? | change:healthcare http://healthaffairs.org/blog/2007/10/17/us-health-care-international-scholars-experience-our-system-what-they-would-change/comment-page-1/#comment-10303 What are we really fighting for… access or choice? | change:healthcare Tue, 23 Oct 2007 20:13:56 +0000 http://healthaffairs.org/blog/2007/10/17/us-health-care-international-scholars-experience-our-system-what-they-would-change/#comment-10303 [...] On October 17th Vidhya Alakeson (in Health Affairs Blog) started my mind on this subject in her article titled US Health Care: International Scholars Experience Our System – What They Would Change. She said: The design of the policy prioritizes the act of choosing rather than the outcome of the choice. Not enough consideration is given to whether the time and effort required to make a choice are justified by the value created by the choice itself, or whether it is possible to make an informed decision. In our experience, this was the difference between choice for choice’s sake and choice that led to a greater sense of control. [...] [...] On October 17th Vidhya Alakeson (in Health Affairs Blog) started my mind on this subject in her article titled US Health Care: International Scholars Experience Our System – What They Would Change. She said: The design of the policy prioritizes the act of choosing rather than the outcome of the choice. Not enough consideration is given to whether the time and effort required to make a choice are justified by the value created by the choice itself, or whether it is possible to make an informed decision. In our experience, this was the difference between choice for choice’s sake and choice that led to a greater sense of control. [...]

]]> By: Farmanux News http://healthaffairs.org/blog/2007/10/17/us-health-care-international-scholars-experience-our-system-what-they-would-change/comment-page-1/#comment-10029 Farmanux News Thu, 18 Oct 2007 17:59:56 +0000 http://healthaffairs.org/blog/2007/10/17/us-health-care-international-scholars-experience-our-system-what-they-would-change/#comment-10029 [...] U.S. HEALTH CARE: International Scholars Experience Our System What They Would Change Editor s Note: This is part two of a two-part blog by several of the 2006-2007 Commonwealth Fund Harkness Fellows. Part one, which ran yesterday, describes the extent to which these international scholars felt able to make meaningful choices in their interactions with the American health care system. In part two below, the authors propose changes […] Fatal error: Call to undefined function add_submit_it() in /home/s0329a42/public_html/wpnews/wp-content/themes/adsminded/single.php on line 24 [...] [...] U.S. HEALTH CARE: International Scholars Experience Our System What They Would Change Editor s Note: This is part two of a two-part blog by several of the 2006-2007 Commonwealth Fund Harkness Fellows. Part one, which ran yesterday, describes the extent to which these international scholars felt able to make meaningful choices in their interactions with the American health care system. In part two below, the authors propose changes […] Fatal error: Call to undefined function add_submit_it() in /home/s0329a42/public_html/wpnews/wp-content/themes/adsminded/single.php on line 24 [...]

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