HCCD Report South Carolina 29401

Group Submission

Charleston, S.C. Regional Health Care Community Discussion

December 30, 2008

Introduction

For several years, the Charleston, S.C. region has been convening groups of community leaders from hospitals, physicians groups, employers and the non-profit sector to address the ongoing challenge of promoting wellness and providing adequate health care to all of our citizens.

Our Health Care Community Discussion for the Obama-Biden Transition Team was organized by Bill, a community leader who has been involved with health care issues for many years. The event was hosted by Trident United Way. Since we knew many people who were already engaged in dealing with health care issues in the region, we directed our invitations to them. We also invited others who heard about our meeting and asked if they could join us.

We were pleased that 30 participants joined us on Tuesday, December 30^th from 8 a.m. to 10 a.m.  Several people made the two-hour drive from Columbia, S.C. to be with us that morning, including State Representative Anton, who served as state Political Director for the President-elect’s 2008 presidential campaign.

Other key participants included Dr. Ray, president of  a Medical School, Ronald, director of health clinics, Dr. John, regional director for a Department of Health and Environmental Control, the chief executives of two other area hospitals, as well as representatives of primary care physicians groups in the Charleston region. The nonprofit sector included representation from The Palmetto Project, developer of the innovative “Patient Navigator” program, the SC Appleseed Legal Justice Center, SC Fair Share, Trident United Way, and the South Carolina Small Business Chamber of Commerce.

Our report

It was clear from the discussions that the group was in general agreement with the three key elements of the President-elect’s health care plan as outlined in the Participant Guide.

Local focus. The initial comments from the group focused on local issues, particularly the degree to which wellness and health care services in our region are highly fragmented, leading to a number of problems:

• Lack of comprehensive health care education and information for our citizens, including guidance on how to access available care and maintain healthy lifestyles. Encouragement and support for behavioral changes that improve individual health and wellness are an essential component of health care reform.

• Duplication, overlap and turf battles between both non-profit and for-profit providers of health related services leads to inefficiencies and gaps in the delivery of services. “We don’t talk to each other” was one comment on this issue.

• There was general agreement that health care reform needs to take place at the local level along with whatever programs, policies and funding mechanisms are implemented by the federal government.

• It was pointed out that even though emergency rooms and non-profit or government-funded clinics can provide urgent and primary care to those without health coverage, there is often no funded way to refer those patients to specialists or other medical resources for follow-up treatment, leaving them abandoned by the health care system after initial treatment at emergency rooms and clinics.

Common themes.

• We need to develop a “well” healthcare system based on wellness and prevention instead of a “sick care” system. This starts with education in childhood about what it takes to maintain good health throughout life, including good nutrition, regular physical exercise and proper primary medical, dental and mental health care. It continues with health education and access to effective primary care throughout a person’s lifetime.

• Our health care “system” is not really a system. It is fragmented and many parts of the system are primarily focused on maximizing profit. In a real health care system, the primary focus would be on getting the best health care outcomes at the lowest cost, and the profit motive of individual providers of goods and services to the system would be secondary to that goal.

• We need a better model for funding medical education. Currently, doctors and other health care professionals incur high debt loads to finance their training.  This creates incentives to select higher-paying specialties at a time when there is a desperate need for primary care physicians (many of whom are leaving the field).  This lack of funding also limits the total number of people who have access to medical education, even as the need for physicians, nurses and other health care professionals is growing. We also need to encourage more diversity among candidates for medical training in hopes of doing a better job of serving minorities in their communities and broadening the pool of candidates for medical training.

• The nation needs some form of universal health care. The failure to insure that every citizen has access to affordable health care is a major reason for the chaos and fragmentation of the delivery of health care in this country, and goes a long way towards explaining why our country ranks below many others in the overall health and longevity of its citizens. It is also a source of severe financial distress for millions of families and individuals across the country.

Specific recommendations

• There is a need for continuing government funding for medical education, including physicians and other health care professionals. The offer of funding can be used as an incentive for health care professionals to serve in rural areas and in specialties (such as primary care) where more services are needed and shortages are the greatest.

• Combine and consolidate federal health care programs such as Medicare, Medicaid and Tricare for greater efficiency and consistency in the programs.

• There is a danger in just “tinkering with the system at the edges.” If the approach to health care reform is too incremental, there will be little progress and the critical goal of significant improvement will not be achieved. We must create a real health care system that is designed to achieve the core goals set forth in the President-elect’s proposals.

• There are reasons to be concerned about relying primarily on businesses to provide group health care to a large portion of the insured population. People change jobs more often, have periods of unemployment, and many small businesses cannot afford to offer or help pay for group health coverage for their employees. An alternative source for access to affordable health care coverage is needed, as envisioned in the President-elect’s National Health Insurance Exchange proposal.

• We need to address over-utilization of diagnostic testing, sometimes caused by physicians practicing “defensive medicine” out of fear of malpractice liability. We need to make sure that medical malpractice insurance is not so onerous that it drives physicians away from practice in needed specialties. Tort reform or other measures may be needed to address this. 

• We must support legislation and programs that will bring medical practice into the 21^st Century in terms of using information technology. The creation of electronic medical records systems that support the integration of patient records to enhance the quality of medical care provided to individual patients is critical, as is the gathering of large-scale data to determine “best practices” to deliver effective medical care and avoid unnecessary care.

Respectfully submitted to the Transition Team on January 4, 2009:

Bill, Moderator