Putting the quality back in health care

Health-care providers need to join with consumers to support comprehensive health-care reform.

By Lisa Rabasca
Monitor staff

Just 10 years ago, consumers had high hopes for managed care , seeing it as a way to cut escalating health-care costs. But experience with managed-care companies has changed consumers? attitudes significantly. Today, they want reforms that will guarantee them greater access to quality care.

This change in public opinion has placed health care at the center of political debate, opening the door to reform, said Russ Newman, PhD, JD, APA?s executive director for practice. The next step is for consumers and health-care providers to join together to reach out to employers and build consensus on how to reform health care, said Newman at the APA Annual Convention session 'A rising call for quality health care: reforming the system through unified advocacy.'

APA has succeeded in efforts to build a consensus with consumers, Newman said. Recently, APA partnered with the Center for Patient Advocacy in McLean, Va., to send nearly 34,000 cards supporting health-care reform to Congress. And 35 consumer and public advocacy groups, including the American Association of Retired Persons, Families USA and the National Association for Women, participated in the APA Convention session on unified advocacy.

'That kind of effort and partnership is what eventually will give us the kind of solutions and fix to the problems of health care we need,' he said.

While consumers and providers do not yet have a solution for fixing health care, they do agree that market reforms put in place in the 1990s are not working. In the 1990s, consumers welcomed market-driven solutions to containing health-care costs because spiraling expenses were seen as a potential threat to the country?s economy, said Newman. In 1993, Americans were allocating 13.9 percent of the gross national product to health-care costs, compared to 5.9 percent in 1965.

'Better than any other statistic, that reflects what set off a whole series of events that we now talk of, know of and, in part, regret,' he said. 'In effect, the pendulum swung from a time when the focus of health care was on quality, treatment and the provision of services, all the way to the other side, to focus exclusively on cost, financing and economics to the detriment of quality care to be provided.'

But, he said, the way health care operates makes it impervious to market-driven solutions. In a traditional free market, poor and costly services disappear because no one buys them and consumers are left with good services at a reasonable cost.

'That has not worked in health care,' Newman said. 'Because of some of the uniquenesses in health care, what you wind up with is only competition around cost issues, not quality, and competition around cost issues leaves you with cheap care, not cost-effective care.'

Shifting public attitudes

An analysis of public opinion surveys from 1990 to 1998 shows that consumers began the 1990s enthusiastic about managed-care plans and distrusting of physicians and hospitals. Today, consumer animosity toward physicians has been transferred to managed-care companies, Newman said. (See chart on next page.)

For example, public opinion polls from the early 1990s show that consumers wanted to contain health-care costs. In 1995, public opinion began to shift after consumers had more experience with managed-care companies, Newman said. For example, consumers were outraged when media stories of 'drive-thru deliveries' revealed that managed-care companies were limiting the amount of time a woman could stay in the hospital after delivering a baby. Managed-care policies that limit care gave way to consumer dissatisfaction with managed care.

Today, consumers support legislation that mandates legal accountability for all managed-care health plans, ensures access to specialists and emergency services without prior authorization and allows for access to providers outside their plan at a reasonable cost. And, he said, most consumers are willing to pay for quality and access.

While patient-protection legislation is viewed by consumers as an effort to regulate managed-care practices, Newman said it should be intended as a way to infuse quality into the health-care system.

Bring business to the table

To discuss the shift in public opinion, Newman invited representatives from five groups to share their thoughts: California State Assemblyman Martin Gallegos; Mike Haley, PhD, of the California Psychological Association; Terre Hall, of the Center for Patient Advocacy; Margaret Kraemer, PhD, of Levi Strauss and Co., Inc.; and Michael Parker, of the Metro New York Health Care and Strategy Practice of KPMG Peat Marwick.

The participants agreed that consumers and providers should approach businesses about reforming health care. Employers are a critical part of the solution.