Category: Vision for Healthcare

Will Baby Boomers bring down Medicare? A cottage industry runs on blaming Boomers for everything (Boom Bust & Echo: Profiting from the Demographic Shift in the 21st Century).

The logic for blaming Boomers goes like this: Boomers make a population bulge.  Boomers are aging.  Old people get sick.  Ergo, old Baby Boomers will overwhelm Medicare.

Despite everything they’re blamed for, old people do not guarantee system failure (and Baby Boomers are not old!…yet).  Age might be one factor.  But many old, sick people access the system less than the young worried well. Of course, most healthcare spending occurs in the last 6 months of life.  An aging population will drive change, but there might be an even bigger factor.

Baby Boomer Attitude

Demographers believe Baby Boomers have attitude.  Not just ‘an’ attitude but attitude.  They know what they want.  They change things they don’t like.

• They won’t put up with waits.
• They won’t put up with no choice.
• They won’t put up with hordes of patients jammed into hallways and EDs because no beds are available.

• They will demand efficiency.
• They will demand great patient service.
• They will want medical experts leading healthcare, not inexperienced bureaucrats and allied health providers.

Boomers expect to stay active, healthy and productive for as long as possible.  They want control.  If early retirement doesn’t impress them, they want to stay fit and working long past 65.  They accept the responsibility of choice and ownership.

Here’s what other’s are saying:

• “If something hurts, they are not going to grimace and bear it.” (Huffington Post)
• Boomers embody involvement, assertiveness, technology, freedom, independence.  (American Medical Association)
• Changes in radiology from Boomers – engagement, mobile access, choice. (Medical Imaging Talk Blog)
• Book: Baby Boomers: Can My Eighties Be Like My Fifties?

Baby Boomers in 10 Years

When we look back, people might ask, “Hey, weren’t you involved back then?  What did YOU do to improve things?”

We can advocate for change now.

• Fly patients to the USA when wait times exceed a limit….say, 4 weeks?
• Reward hospitals only when they see patients, instead of before they see patients (block funding), or only when they follow recipe care (QBPs)?
• Ask patients what Canadian healthcare could learn from other industries, other countries?
• Ask patients whether they think healthcare should be as good as pet care or prisoner care?

What do you think?  Baby Boomers have reshaped everything they’ve ever come up against.  How will they reshape healthcare?

 photo credit: check out Swimsuit protest from feistysideoffifty.com

Given enough fear, people welcome control.

Sickness and trauma scare us. Patients need to hear, “It’s okay. Don’t worry. You’re going to be all right.”

Fear begs action.

Scared people want someone in control. In the past, doctors and nurses calmed fears.  Patients just focused on recovery.

Medicine got better.  Worry about sickness decreased, and worry about hospital bills increased. Losing homes became as much a concern as losing health.

Media sells on fear, especially in the USA:

• Medical Bills are the Biggest Cause of US Bankruptcies – Study
• Why Medical Bills are Killing Us (TIME Special Issue)
• Sticker Shock: Investigating the High Cost of Hospital Bills

Desperate Times Call for Drastic Measures

Extremis malis extrema remedia

Pundits leverage people’s dread of sickness. Panic about rare, high-cost medical catastrophes justifies command and control over delivery of everything else.

People don’t panic over high blood pressure or diabetes.  But most healthcare dollars go to chronic disease and risky behaviour in the USA and in Canada.

Paradoxically, central planners back off a little in the provision of high profile, newsworthy medical care. Trauma care works best when doctors set up systems guided by outcomes.   Bureaucrats let medical experts design delivery and just pay the bill; it’s a much smaller portion of healthcare spending anyways.

But fear about medical bankruptcy justifies more and more micromanagement of everything else.

Healthcare Control

Service, quality and efficiency needs empowered front line providers.  Patients suffer when physicians are bound by rigid guidelines, shackled by fear of lawsuits and motivated by perverse incentives. Patients benefit when providers are incentivized to meet patient needs, not system rules.

Command and control does not work in business (Command and Control Leadership Doesn’t Cut it Any More – Globe and Mail).  It will never work in healthcare.  But fear continues to justify military-style leadership leaving patients on the sidelines as costs.

Most of us support a safety net for rare, catastrophic illness.  It’s dishonest to use legitimate fear about medical catastrophe to allow central healthcare control that harms patient access, service and quality.  For the bulk of healthcare spending, we should empower patients and providers and let them drive service, quality and efficiency.  We should stop supporting central command and control.

What do you think?  Do we need more centralized, bureaucratic healthcare control or less?

 Photo credit: engageforsuccess.org.  Check out their post on Command and Control.

“But your patients expect to see you,” she said.  “It doesn’t matter if it’s 8 o-clock at night… When I need my doctor, I expect him to answer.”

My mother’s words still echo 25 years later.  She nursed 2 floors of Alzheimer’s patients by herself. She’s practical and tough with medical concerns.  She managed most things without any support, largely alone, at night, with very sick patients.

When she finally calls a doc, she expects an answer.

Physicians used to be available 24-7.  They slept in hospitals as much as home.  It grew out of guilt, duty, greed, social expectations, escape from personal relationships…a complicated list.

24-7 created some odd physicians.

People now realize that healthy providers give better care.  Patients benefit with doctors fully engaged, fully aware.

Guilt

“There’s a patient who needs…[some great need]…up near [some place 40 minutes away].”

The one, lost sheep…

Often lost sheep have many people who could help and might even do a better job of helping.  But physicians feel a ‘proper’ doctor would go and attend.

Driving 30-40 minutes, one way, to see one healthy patient while making 8-10 other patients wait or rebook appointments is not model behavior.  It is not altruistic.  It is profligate, wasteful.

Healthcare Waste

Payers and auditors obsess over unnecessary tests and visits.  They care less about efficient use of physician time.

Patients benefit when physicians spend time with them.

No matter what else planners dream up, the system should always maximize physician efficiency to keep maximum time available for patients.  Regulations, bureaucracy, forms, record keeping for 3rd parties, audits, and quality improvement projects must be measured by the time they steal from patients with their doctors.

Guilt & Waste

Provider guilt works like another layer of wasteful bureaucracy.  It often makes physicians steal time from dozens of patients by pretending to model sacrificial behavior for one.  Guilt often blends with pride; providers like people to know about our sacrifice and hardships.  Often our stories of sacrifice are examples of time stolen from other patients who needed us more.

Efficiency is…

Everything we do means something else cannot be done.  Thankfully, patients now expect their physicians to maintain their personal and family life.

We need the system – and all the providers in it – to insist physicians stay maximally efficient.  Before all else, healthcare efficiency should start with measuring how much time physicians could be spending with patients if they didn’t waste it somewhere else.

Photo credit: nytimes.com