By Price, Donald L.
The World and I , Vol. 14, No. 4
Ten times more people die each year from reactions to prescription drugs than from using illicit drugs. More than 40 million Americans are uninsured. One in four women over 50 has not had a breast or pelvic exam in the past year. More than 180,000 people die every year because of physicians' errors, and thousands of others are left with permanent damage because of medical mix-ups, surgical errors, mistakes in judgment, and treatment for the wrong diseases.
Hundreds of statistics point to why we must reform our health-care system, but the statistics don't tell us where to start. Everyone's talking about health-care reform, but so far no one--not politicians, government officials, advocacy groups, or citizens--has proposed a feasible or achievable approach to creating an ideal American health- care system.
Right now, our health-care "system" is a mixture of loosely organized, fragmented practices led by hospital corporations and specialty medicine under the financial control of the insurance industry. By focusing on reducing costs, our leaders have encouraged managed competition instead of managed care; they haven't brought costs under control or improved health care.
The current state of health care is far from ideal. For many Americans, health care is rationed, and often those charged with promoting health- -from doctors and nurses to pharmacists, therapists, and technicians-- end up repairing or restoring their patients' health, instead of promoting it. They deal with the failures of health care.
WHAT IS HEALTH?
What is an optimal health-care system, and what should we do to improve our current system's inefficient, ineffective, or missing aspects? Let's turn first to defining health itself.
We cannot develop an optimal health-care system using dictionary definitions. Employing such definitions, we can only say that a person's health is good or bad--which may or may not be realistic. Jake, for instance, appeared to be healthy yesterday, but today he died. A full and accurate definition of health must recognize that people are exposed to various hazards and respond to them differently. Health, then, is the measure of a person's ability to respond to insults--any event or agent, be it biological, physical, chemical, mental, social, or cultural--that confront or affect him. The better the response to an insult, the better the person's health.
Using this definition, expressing whether someone is healthy could be approached in several ways. Since health measures response to insults, an individual's health could be measured by creating a profile of that person's expected response to a variety of health insults. Another measure of health could develop a profile based on body systems. Regardless of the approach used, creating and standardizing health- status profiles--and making them an integral part of patient records-- would allow health-care practitioners to detect changes in health more easily and help them to diagnose problems quickly and effectively.
POSITIVE PROMOTION OF HEALTH
Since physicians arguably hold the most important position in health care, defining their contribution to an optimal health-care system is crucial. Their primary role should be to detect deviations from an individual's healthy state (detection), determine what is causing the deviations (diagnosis), and apply measures to correct the diagnosed problem (treatment, repair, and rehabilitation). In addition, physicians should establish each patient's health status through a baseline profile (evaluation) and educate and advise the patient on health, wellness, and prevention (education). These tasks are not generally possible unless the physician has access to adequate patient information to establish a baseline health profile. This means that the patient must regularly obtain health care from the same physician or group and that the mode of health-care delivery fosters continuity of care. …