Transforming health care Featured

9:49am EDT March 22, 2005
Consumers set the agenda, influencing the prices of products and services they pay for in every sector of the U.S. economy -- with the exception of health care.

However, that inequity in America's economy is changing with the emergence of health care consumerism. As health insurers engage, educate and empower consumers with tools, choices and technology, consumers can make more informed health benefits decisions for themselves and their families. In response, insurers are offering a growing array of consumer-directed health benefit plans to businesses and individuals.

Former Speaker of the House of Representatives Newt Gingrich recently addressed the "transformation of health care" as a keynote speaker at the Atlanta Association of Health Underwriters (AAHU) Benefits Forum 2005.

The former House speaker focuses on health issues in the private sector as founder of the Center for Health Transformation in Washington, D.C. The center is a collaboration of public and private sector leaders dedicated to the creation of a 21st century intelligent health system in which knowledge saves money and lives.

Gingrich's vision promotes the individual's right to know health care cost and quality, and asserts that better quality leads to lower overall costs. Gingrich doesn't want to change our current health care system; he wants to transform it by correcting the way people behave.

In his new book, Winning the Future, Gingrich articulates his argument for transforming health care in America.

"Virtually every political story about health focuses on 'reforms' for our problems: the rising cost of health care, the challenge of the uninsured, the state and federal budget crises, the high cost of drugs, litigation, nursing shortages, doctor unhappiness ... The truth is that the current health system cannot be reformed because its approach is profoundly wrong in three specific areas," he writes.

"First, it emphasizes acute care rather than wellness, early detection and prevention. Second, it focuses on third-party payments, an area in which the individual has little responsibility, little knowledge and no control. And third, it relies on paper (i.e. paper medical records and paper prescriptions), rather than information technology ... We need to transform our health care system based on an entirely new set of principles."

Here are other insights, ideas and perspectives on the state of health care in America that Gingrich shared recently with the AAHU Benefits Forum 2005.

* The current structure is a triangulated system of conflict, fraud and frustration, mired in inefficiency and complexity.

* A direct buyer-seller system is much healthier. It encourages health care providers to focus on quality, efficiency and satisfying the patient rather than the insurance company.

* As technology creates the availability of online, real-time medical information databases, physicians and patients will use that information to improve their care and their lives.

* At the same time, as health care costs continue to climb, employers will demand that employees pay more for their own care. As a result, the appeal of tax-free health savings accounts will grow.

Gingrich's plan for transforming American health care has three core principles.

* Focus on wellness, early detection, prevention and maximum quality of life -- the individual carries a substantial part of the responsibility for his or her own health care.

* Provide easy access to information about cost, quality, wellness, prevention and choice through an information technology system available online.

* Keep the system centered on the individual, who has the financial incentives and information to make smart health care purchasing decisions.

Gingrich believes we can dramatically improve the country's flawed health care system by improving the people who use the system. The system will cost less, he maintains, because healthy behavior will result in lower costs.

Alan Guzzino is the president of Humana's Atlanta, North Carolina and South Carolina market health plan operations and is responsible for the management, strategic planning and growth of those markets. Guzzino, an eight-year veteran of Humana, serves on the board of the Georgia Association of Health Plans. Reach him at aguzzino@humana.com.