In order to protect the public interest and safety, a universal health program must require maintenance of high standards for professional training. Professional scope of practice must be based on training, not lobbying. Physicians and other providers should be required to maintain membership in a professional organization, tied to licensure, to ensure that peer review and professional ethical standards are enforceable, and to promote continuing education. A universal program will also require organization of physicians and other professionals for negotiation of fees with the program, and for participation in quality improvement. The program should harness professionalism to keep health care equitable and cost-effective. The net income potential for professionals must be commensurate with the training and skills necessary for their scope of practice, and any reduction in professional pay must be tied to reduction in administrative burdens (cost, time, and hassles), reduced risk of lawsuits, and subsidies for training costs.
5. Quality Improvement
A system-wide quality improvement program with professional leadership should replace managed care administered by insurance companies. This program should follow William Deming's Continuous Quality Improvement (CQI) model and focus on improving processes of care, rather than just HEDIS style quality measures. Unlike CQI, other strategies to reduce unnecessary and inappropriate care such as capitation, rating providers, pay-for-performance, and incentives based on outcomes are problematic because they create disincentives to treat difficult and complex patients.
6. Ensure adequate professional work force, especially for primary care
A universal program should improve payment for care coordination. Patients with significant chronic illnesses should be assigned to a "patient-centered medical home." Primary care can also be encouraged with a state-level program similar to the National Health Service, with subsidies for medical education and training tied to commitment to practice in underserved areas and specialties.
7. Accountability must be to the health needs of the population
Health system policies, including fee structure, scope of practice issues, formularies, and covered benefits, must be set by a health authority that is accountable to the health needs of the community and insulated from special interests and lobbying. Funding for capital improvement in hospitals, nursing homes, diagnostic imaging centers, etc. should be determined by public health needs. Health care financing and institutions for delivery of care must both be not-for-profit. A universal health system will benefit from a continuous quality improvement program for administrative systems as well as for health care delivery, with robust feedback from providers and patients that can actually influence policies.
8. Separate, sustainable funding for health care
A universal health system must have its own separate funding stream, whether this is called a health tax or a premium. There must be no mixing of health care funding with general tax revenues. Funding must be responsive to actual costs of care and public health priorities.
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