7 of 8 people found the following review helpful:
3.0 out of 5 stars
A Good, but Flawed Start, March 7, 2008
This review is from: Health Care Reform Now!: A Prescription for Change (Hardcover)
Halvorson has initiated a public conversation about health care in the United States. Halvorson postulates that adequate healthcare can be provided to everybody without increasing the cost of care. He would take advantage of the following:
* A small minority of the health care consumers use the major portion of health care dollars. The bulk of this is attributed to chronic illness that goes untreated until it becomes an acute (and expensive) crisis.
* The multi-provider model of health care currently in the market is extremely inefficient, especially when coupled with paper medical records.
* Cost shifting as the uninsured present to hospitals or emergency departments where they cannot be turned away. This is the most expensive care possible. These costs are shifted to private insurers.
Halvorson designs the idea of an IV or Infrastructure Vendor. The IVs will create medical record systems allowing individual providers access to all the information they need for a patient's total care. Reminders for tests and treatments for chronic illness will come up.
Halvorson sees that one primary problem with the American health care system is a badly incented market. Financial incentives exist for treating illness, not for securing health. His solution is to capitate payments for chronic illness so that the providers have more incentive to keep their patients healthy.
Finally, Halvorson would require health coverage for everybody so that no cost-shifting occurs. Halvorson embraces the "six sigma" concept for health care providers adhering to best practices and evidence based medicine.
Halvorson's reliance on medical information systems to help solve health problems is wishful thinking. The system deployed by Kaiser has been described as implemented in a way that fails to fulfill the requirements that Halvorson raises. One employee told me that she could order a vasectomy on a woman without raising any errors or flags.
Another problem is Halvorson's failure to address the roles of line workers. While he cheers for 6-sigma, he ignores the wisdom of Total Quality Management or other programs designed to allow worker input to help solve system problems. Again, this is a complaint of Kaiser employees who have some influence in corporate processes, but are mostly ignored when it's time for the big decision.
Still, Halvorson has good ideas, which ought not to be totally discounted. Providing preventative health care for chronic conditions CAN drastically lower care costs. Kaiser is one of the few insurance systems that provides full chemical dependency care at no extra charge, thus saving the costs of liver transplants, heart failure, pancreatitis, and other drug and alcohol related problems.
Think of this book as a conversation starter ... a point of starting a national dialog to move national health care forward.
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4 of 4 people found the following review helpful:
5.0 out of 5 stars
Great Practical Guide to Health Care Reform, July 5, 2008
This review is from: Health Care Reform Now!: A Prescription for Change (Hardcover)
George Halverson does an exceptional job at laying out the major issues facing the United States health care sector and systematically making practical suggestions for reform. Having been on the inside of Kaiser in California, Halverson has an in-depth knowledge of the complex interplay between physicians, payers, patients, providers, hospitals and the government. Four of his most powerful messages are how to harvest existing personal health records, the need to focus on chronic disease, how to create intermediary agents that pursue high quality and efficient care, and the fundamental necessity of universal health care coverage. Although that last reform is left-leaning, the author's perspective is balanced and he supports reforms to make health care markets work and reduce unnecessary administrative waste. One of his most resounding messages is that we get what we pay for in health care; currently we have over 9,000 billing codes for treating disease and not a single way to bill for a cure or maintaining wellness.
As a health care professional for the past six years, I highly endorse this book to both novices and experts alike. The challenges that await health care reform are large and complex, but it is the articulate and well-though advice of veterans like George Halverson that will make long-term advancement possible.
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22 of 30 people found the following review helpful:
1.0 out of 5 stars
One of the central arguments in this book is deeply flawed, October 12, 2007
This review is from: Health Care Reform Now!: A Prescription for Change (Hardcover)
The chapter on chronic conditions is a very interesting read--as is the author's argument that we need to identify people with these conditions (based on better data) and intervene before their conditions progress to a higher cost state--chronic disease costs the health care system a fortune. The problem with this chapter (and a central argument in this book) is that it has already proven to be unworkable and untrue. The Congressional Budget Office analyzed the watershed of literature on disease management and concluded it does not lead to savings. The interventions the author speaks of are often not successful, nor cost saving. Indeed, if the argument were true, the own author's health plan--which rigorously practices case management and disease management--would have already seen the cost savings. The fact that the health plan's costs (and premiums) are no lower--and in some cases are higher--than the industry average is a strong counterargument. Moreover, the author himself--a self acknowledged heart attack patient is yet another example of why early interventions for chronic disease patients are often not successful. An overweight patient with high cholesterol can visit his physician--who may prescribe diet, exercise and cholesterol medication...but then, it in the patient's hands to follow doctors order and modify his or her lifestyle accordingly. Many do not. How to not only encourage--but ensure--high risk patients purse lifestyles that include healthy eating and active living may be the central challenge facing medicine--and our county--today.
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