On Point: The State of Healthcare in
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. Weíve got nursing shortages,
overfilled emergency rooms, escalating costs across the board, and the
highest number of uninsured people in the world. Itís a sorry state, and
pretty counterintuitive, since we are also the richest country in the
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 ďone of the worst hospitals in California and,
in some respects, the nationĒ after the much-publicized shutdown of its
trauma center. Although only the negatives are frequently published, Iím
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, itís still a big question mark how their challenges are going to
affect all of us, even those who donít utilize their services or who
donít live in the area, because it will put a crunch on other nearby
On assumptions of managed care
Managed care is here to stay because employers are under the assumption
that it saves money, but Iím not sure it does. I think a lot of the
ďsavedĒ 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. Thatís controlling
costs by giving them greater control.
On the rising cost of employee benefits
I donít 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 wonít
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.
Thereís this mind set out there toward healthcare that says, ďyou have
to take care of me.Ē We have to change that to ďI have to take care of
myself.Ē That means educating yourself, knowing your own body, finding
out what resources are available to you, understanding the extent of
your health care coverage Ė becoming your own advocate in as many ways
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 Ė 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 youíre at high-risk and should demand a
base-line mammogram now, not when youíre 45.
Itís up to you to tell your doctor you would like to discuss such
preventive services when you schedule an appointment. And follow-up Ė
itís not a definite that your doctor will remember when you asked for
services. Thatís your responsibility to remember. It may be time
consuming and cost you some more money, but whatís 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 Foundationís 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 doctorís 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 Ė but itís pretty obvious if you donít do it, no one else will
do it for you.