Ensuring the health of Tarrant County residents

From rising medical costs, poor access to physicians, and a lack of adequate health insurance for nearly 16 percent of Americans (47 million in 2006, according to the U.S. Census), itÂ’s no wonder that people consider our health care system broken.

The lack of insurance is affecting health outcomes in Texas, where our state ranks 49th, according to a report by the  Commonwealth Fund Commission on a High Performance Health System. The study adds 30 percent of Texans older than 65 lack affordable insurance, the largest percentage in the United States. And according to the World Health Organization, almost one in four (24.8 percent) Texans lack insurance.

Why should business leaders care about this situation? When patients arenÂ’t covered by insurance, there is a profound shift in costs from the uninsured to the insured, which creates a wicked cycle of increasing costs for businesses. This reduces the competitiveness of our businesses on the world stage, when compared to companies located in countries with more effective health care systems.

But while increasing the number of insured citizens may offer some help, itÂ’s no silver bullet. In fact, the Commonwealth study also discovered that communities with high insured rates often present lower-quality health care services. Why? Overconsumption of poorly coordinated, expensive (and sometimes non-beneficial) services results in high-cost, low-quality care. Additionally, community health providers canÂ’t always afford the latest diagnostic and treatment equipment or pay top salaries to recruit and retain top-quality physicians, nurses and assistants.

An additional problem: an ongoing shortage of primary care physicians – those trained in general internal, family or pediatric medicine. A recent article in the AARP (American Association of Retired People) Bulletin (September 2008) notes that more than 3 percent of Medicare beneficiaries – about 1.3 million people – “have difficulty finding a new primary care physician.” The article goes on to say that as the first wave of the nation’s 78 million baby boomers turn 65 in 2011, the physician shortage will get much, much worse.

Clearly, the health care conundrum is complex and lacks easy solutions. But it seems reasonable to assume that increasing the number of insured citizens, while also increasing the number of well-trained primary care physicians and health care professionals, has the potential to help.

In Texas, we can start this grassroots effort by reflecting on a study from  Dartmouth Atlas that found regions of America with a greater proportion of primary care physicians operated at lower cost and offered higher quality care. We can also consider a recent study by the American College of Physicians that compared the U.S. health system with those of 12 other countries and analyzed why the latter had better medical outcomes for far less funding. They found that systems based in primary care offer less expensive and better quality care.

We can commit to increasing the dialogue between public health organizations and medical schools to encourage new medical training strategies that donÂ’t emphasize overspecialization. We can lobby for changes in insurance reimbursement policies, like those that pay doctors $30,000 to amputate a diabetic foot, even though most amputations are preventable by reasonable diabetic and foot care that costs less than a thousand dollars (but isnÂ’t covered by insurance).

We can also consider innovative new approaches, such as establishing “patient-centered medical homes” that allow patients to enter into ongoing relationships with physicians who lead teams that coordinate care. As noted by the aforementioned AARP article, only two such practices, in Maine and Maryland, meet the standards set by the National Committee for Quality Assurance. Surely we can increase these numbers for more positive impact.

My point is this: the seemingly insurmountable issues that the health care industry faces are not impossible to solve. We must look to other states and nations that have initiated successful health care improvement programs. We need to reach out to city and county officials and initiate dialogues that will result in healthier communities. To bring our health care system up to the standard that this country deserves, we must apply the same kind of innovative reasoning and desire for better access to high quality medical services that informs every good doctor-patient relationship.

Ransom is president and professor in obstetrics, gynecology,

health management and policy at the University of North Texas Health Science Center at Fort Worth.