It is important to distinguish between health reform and health insurance reform. Lately, the debate has shifted to health insurance reform, which deals with coverage. Meaningful health reform is about creating the proper incentives for providing care. This is where the real improvements can be made, but it is a massive undertaking.
Q: You mentioned a comprehensive approach, i.e., clinical integration, as one of three important issues in the health care debate. Could you define what you mean by that? Do you want this to be part of a health care reform bill? How does it tie in?
A: One of the ways that we see of effecting change in this area is clinical integration, which we define as physicians and hospitals working in an interdependent way to produce better outcomes in the most cost-effective manner. It requires that there is the discipline to develop and implement clinical- and evidence-based guidelines for best practices, as well as working together to assure the most effective exchange of information.
Dr. Stephen Kotch
chairman
Department of Emergency Medicine,
Washington County Hospital
Q: You said you favor universal health care. Why? What would that mean to your patients?
A: I am in favor of the concept of universal health care -- meaning access to health care for all people. However, this does not necessarily translate that I support the concepts of health care reform as proposed currently.
"Universal health care" would idealistically mean the majority of my patients in the ED (emergency department) would have access to primary care, subspecialty follow-up, routine well-checks and immunizations. Again, speaking only from the standpoint of emergency medicine, this would mean ED physicians could focus more on acute-care medicine.
Currently, limited access to primary care physicians, coupled with a lack of insured, leads many to utilize the ED as their primary care providers. This creates a twofold problem.
First, EDs become overwhelmed with nonacute medical problems, potentially causing delays for those in need of emergent intervention.
Secondly, this has significant financial implications in that this patient population generally requires more testing/evaluation, typically at increased cost.
Q: What would it mean for doctors? Would it limit the amount of money doctors could make? (private practice vs. those who work for hospitals)
A: I am really not sure of the financial impact on the physicians. From an ED standpoint again, volumes have been increasing over many years, while EDs are closing across the country due to financial strains.
Q: How would tort reform that would limit malpractice liability be a benefit to doctors, hospitals and patients?
A: Tort reform would, without a doubt, decrease expense incurred by physicians and physician groups. This has already been demonstrated in states with tort reform, such as Texas and Missouri. Premiums have decreased up to 40 percent. Theoretically, these savings should be passed along to consumers, i.e., patients, through decreased insurance premiums and cost of care.
Q: Are patients who do not have health insurance turned away from the hospital, the emergency room ... private doctors' offices?
A: All patients presenting to the ED across the country are entitled to a medical screening examination to determine the presence of an acute life-threatening condition. Therefore, no patients are turned away from the ED. Private physicians often require insurance or some form of payment in advance for services. Again, this need is reflected in the rising cost of practice operations, malpractice, etc.
It certainly is a large problem, summarized with increasing costs, increasing risk, increasing volume of patients, and decreasing reimbursement from government and private sources. A solution which will lead to universal health care will need to address all of these issues. It is my opinion that this (solution) is currently not available.
Albert Pilkington III
president and CEO
West Virginia University Hospitals-East
Q: You said that you might favor some form of universal health care. Can you explain your position in more detail? Does that mean every person having health insurance?
