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.