Based on years of research and teaching on healthcare topics, Iris Baxter, assistant professor of public administration, designed and created the new Healthcare Issues in Public Administration class that debuted last fall. Here, she addresses what she calls a crisis in our healthcare system, misnomers of managed care, never-ending cost increases, and what every American should do to make sure they are taken care of.

On the crisis
The three major issues in healthcare are access, cost and quality. And any change in one affects the others. We’ve got nursing shortages, overfilled emergency rooms, escalating costs across the board, and the highest number of uninsured people in the world. It’s a sorry state, and pretty counterintuitive, since we are also the richest country in the world.

On issues hitting home
At the very least, the situation with many of the local hospitals shows the crisis is nothing new around here. Last month, the L.A. Times called King/Drew Medical Center “one of the worst hospitals in California and, in some respects, the nation” after the much-publicized shutdown of its trauma center. Although only the negatives are frequently published, I’m sure there are numerous positive outcomes that have occurred at King/Drew. The general perception is that the King /Drew problems stem from various issues that involve management and quality of care. In the end, it’s still a big question mark how their challenges are going to affect all of us, even those who don’t utilize their services or who don’t live in the area, because it will put a crunch on other nearby hospitals.

On assumptions of managed care
Managed care is here to stay because employers are under the assumption that it saves money, but I’m not sure it does. I think a lot of the “saved” costs are replaced by a layer of administrative costs that may make managed care just as expensive or even more expensive than the traditional model. Plus, you may not get the care you need because your primary care provider acts as a gatekeeper on your health, which restricts your access to specialized care. You may come in wanting treatment for multiple problems but the provider might try a series of medications before referring you to a specialist. That’s controlling costs by giving them greater control.

On the rising cost of employee benefits
I don’t see an end to the rising costs of health care benefits. There are a number of reasons for these increases like our demand for access to cutting-edge technologies and the growth in the aging population, but a major one is the growing number of uninsured and working poor. They go to the emergency room for care, and we as a nation have decided we won’t turn anyone away, whether they can pay or not. The hospital ends up writing that off as an expense, and that cost is eventually deferred to the insured in the form of rising insurance costs.

On responsibility for your own health
As individuals, we have very little control over all these things I just talked about. But we can take more responsibility for our own health. There’s this mind set out there toward healthcare that says, “you have to take care of me.” We have to change that to “I have to take care of myself.” That means educating yourself, knowing your own body, finding out what resources are available to you, understanding the extent of your health care coverage – becoming your own advocate in as many ways as possible.

On being your own advocate and making your doctor work for you
That starts with taking the time to evaluate your healthcare options when you start a new job – and not just based on whatever is the cheapest option. Another way we can become our own advocate is by demanding preventive healthcare services. Know your benefits and have a thorough discussion with your provider annually. Ask him or her what type of screening examinations you should get and when you should get them. For example, if you are a 35-year-old female with a family history of breast cancer, that means you’re at high-risk and should demand a base-line mammogram now, not when you’re 45.
It’s up to you to tell your doctor you would like to discuss such preventive services when you schedule an appointment. And follow-up – it’s not a definite that your doctor will remember when you asked for services. That’s your responsibility to remember. It may be time consuming and cost you some more money, but what’s the alternative? Waiting until you discover a tumor?

On other resources
When you set up such an appointment, come prepared. Make a list of questions you want answered. There are plenty of good Web sites to research everything you want to know about diseases and healthcare issues like www.hschange.org and www.mdlinx.com. I check out www.chcf.org, which is the California Healthcare Foundation’s site, to keep abreast of all the health policy issues going on in Sacramento. These Web sites are for informational purposes and can be utilized to help you prepare for your next doctor’s visit.
   All of this can seem overwhelming and time consuming. Although I am quite familiar with the health care system, I too feel overwhelmed sometimes – but it’s pretty obvious if you don’t do it, no one else will do it for you.