The Health Care Debate

You can’t turn on the TV or radio, or open a newspaper without hearing or reading about health care reform. It’s great that we’re all talking and thinking about it. I had a chance recently to talk with Dr. Michael Soman, the medical director of Group Health Cooperative, about some health matters. Dr. Soman—and Group Health—have been in the national spotlight for a few reasons: national leaders are wondering if GH’s health care model might be one to replicate and Soman was called to Washington to talk about it. But, as well, he’s also been talking about Medical Home, a patient-centric health care model that’s being adopted by all GH clinics. We wrote about Medical Home in our July issue; you can read more about it here.

In my conversation with Soman, a few things stood out. While the Medical Home model has been around for awhile—and not just at Group Health—GH is the first place that tried to measure, through scientific study, whether the system really had the benefits that anecdotal evidence suggested. Earlier this week, the results of that study were published in the September issue of the American Journal of Managed Care, with dramatic findings. Medical Home patients were found to have fewer emergency visits and hospitalizations (29 and 11 percent respectively), which ultimately has a big impact on the bottom line. But, as importantly, staff participating in the MH model were much happier—only 10 percent experiencing burnout, versus 30 percent in a control group.

The latter impact is very important, says Soman, who was trained in family practice, and worries about the future of family medicine in this country. With lower compensation than other medical specialties, and an existing system that rewards family practice physicians for the number of patients they see daily, many work long hours, seeing each patient for just a few minutes—leading to physician burnout (and patient unhappiness!).

Soman thinks that even with loss compensation, there are many medical students who would choose family practice—if they knew they would have more time to actually spend with patients, and would be able to get off of what he calls “the hamster wheel.” He notes about his own choice to go into family practice: “It’s birth to death: you get a

front row seat to people’s real lives stuff; that’s hugely humbling. That was the core of what I loved.”

Meanwhile, another health care system that’s been getting a lot of debate is NHS, the British system. It’s been much maligned in the media. While I haven’t had experience with it, my daughter has. She has been living in Britain on and off for about three years, first as a student. She’s now living and working in London, with all of her health care courtesy of the NHS. It hasn’t been a perfect experience, she admits—but overall, she’s been able to get appointments when needed fairly quickly, and get routine health care issues resolved quickly. More difficult to get action on—as you’ve likely read—are problems that might require surgery, but that aren’t considered emergencies. There can be a long wait for those. But I marvel at the fact that someone in the country on a visa, is covered by their national system. And I worry what will happen when she returns to this country—most likely without a job right away—and thus, with no health insurance.