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The future of health care is on the table

Professor of medicine discusses what’s not working in hospitals and the world of insurance, at Amos Fortune Forum

Dr. David Fairchild speaks about the future of health care during the Amos Fortune Forum at the Jaffrey Meeting House on Friday night.

Dr. David Fairchild speaks about the future of health care during the Amos Fortune Forum at the Jaffrey Meeting House on Friday night. Purchase photo reprints at Photo Finder »

JAFFREY — Dr. David Fairchild, the latest speaker in the Jaffrey Amos Fortune Forum series opened his lecture with a simple question: “How many of you think our health care system is broken?”

Across the Jaffrey Meetinghouse, hands shot up in the air.

During his talk “Medicine in Transition: Moving from ‘Illness-care’ to ‘Health-care,’” Fairchild explained the gaps he has seen in the U.S. care system, from the point of view of a professor of medicine at the University of Massachusetts Medical School and senior vice president for clinical integration at UMass Memorial Health Care. He and his family are frequent visitors to Jaffrey, where his mother shares a summer cottage near Thorndike Pond with her siblings.

There are some fundamental issues with the health-care system as it stands, explained Fairchild. Among them are the unsustainable cost, the dissatisfaction of the consumer, and a system that puts the emphasis on treating the sick, rather than keeping the population overall healthy. The current system is unsustainable, said Fairchild, and there are certain avenues that health care may have to head down to both address those issues and continue to be affordable for the public.

One of the key issues, Fairchild said, was that in comparison to other first-world countries, the cost of health care is disproportionately higher. Health care costs have increased 112 percent just since 2011, but wages have not shown the same increase.

“It’s certainly unsustainable,” said Fairchild. “If we don’t do something, we’re in trouble.”

Despite that, quality of care is not appreciably better, life expectancies are not significantly longer than other countries, and more than half of citizens are dissatisfied with their care.

There is also no transparency of cost. Health insurance co-pays may be drastically different based upon the negotiating power of the health insurance company, and many hospitals don’t know the actual out-of-pocket costs for common procedures, leading to inconsistent pay structures. And because the public can’t comparison shop based on price, there is a lack of competition.

Also, those that have a low co-pay often request and are granted high-end procedures such as MRIs, whether or not they truly need them. Hospitals allow it, because they will get reimbursement from insurance companies and make more money, said Fairchild. It’s also a system that leads to redundancies, such as not communicating with other practitioners when a patient seeks a second opinion, putting patients through similar tests, rather than transferring records. While this increases profits for hospitals, it increases insurance costs at the other end.

Those that opt for a health care plan with a high co-pay often have the opposite reaction, and will resist high-end procedures they may actually need because they don’t want to pay, Fairchild noted.

There are several ways to change the current model, including taking on a global health care budget similar to a system such as Canada or the United Kingdom. Another is to reduce direct payments for fee-for-service care. Another is to focus on health and a wellness revolution by offering incentives for better health.

One possible future of health care, the one that Fairchild is advocating, is population-based care. A hospital is responsible for the health of their patient population. Not just treating them when they become unhealthy, explained Fairchild, but maintaining their health, which involves measures such as tracking down diabetic patients who have not been in for checkups and offering health incentives.

Such a step would require more administrative funds, and an increase in primary care physicians. Currently, in the United States, there is a dearth of primary care physicians, as more and more doctors enter specialized fields, because the money is better. In order for a population care-based system to work, primary care doctors would have to earn more and specialists less — which is not a popular option among specialists, Fairchild pointed out wryly.

And because patients would still have the option of seeking their care at other hospitals, hospitals and doctors would be forced to make themselves more consumer-focused than they currently are, in order to keep their population coming through the doors.

This is a model that UMass Memorial has begun to implement, led by Fairchild, president of the UMass Memorial Accountable Care Organization. .

Whether or not population care is the solution in the wider arena of health care, there must be something done to transform the system, said Fairchild, and it’s a change that needs to begin now.

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