The American College of Physicians has developed a position paper on universal access in health care — they’re for it.

Why? Because as the good doctors point out, “The U.S. health care system is inefficient and inconsistent.”

The ACP’s rationale for universal access is not driven by a moral imperative to cover all Americans; rather, they argue that by serving a strong central mission of primary care and implementing a robust IT infrastructure, we’ll achieve a high-performance health system.

That is, we’ll deliver health care well and efficiently.

In a far-reaching, richly-researched paper to be published in the January 1, 2008, journal of the Annals of Internal Medicine, the ACP analyzes the current state of American health care in terms of finance and access. Then the doctors compare the US scene with 12 other industrialized countries, finding that the US underperforms in many areas. For these comparisons, the ACP adopts the standards offered by the Commonwealth Fund’s National Scorecard on Health System Performance.

While it’s difficult to compare health systems globally, the ACP offers a few explanations for differentials in US scores vs. other developed countries’. They include:

1. Commitment to Primary Care – Most strongly performing health care systems have primary care at the center of their delivery systems.

2. Control over Workforce Supply – Control over the supply of different types of physicians is another characteristic of well-performing health care systems. The US has a maldistribution of clinicians from Maine to Alaska.

3. Widespread Implementation of Electronic Health Records – The US lags behind many other developed countries when it comes to the adoption of EHRs. This is especially marked in the Netherlands (where 98% of primary doctors use EHRs), Australia, New Zealand, and the UK. In the US, the rate of EHR adoption was 28%, according to the ACP. EHRs are routinely used in the Netherlands, for example, to communicate computerized alerts about potential problems with prescription drug interactions.

The ACP offers six benchmarks for achieving high-performance health care — which they are also using for assessing Presidential candidates’ platforms for health reform:

– Achieve universal health insurance coverage
– Reform health care system to be build on a foundation of primary care
– Create positive incentives to encourage patients to be prudent health care purchasers
– Reduce the costs of health care administration (from liability premiums to administrative costs of multiple insurance carriers)
– Support interoperable HIT infrastructure
– Encourage public and private investments in medical research.

Health Populi’s Hot Points: It’s election year 2008. The ACP is exercising its influence in educating its constituents and other stakeholders in the US health system. As I’ve observed before, primary care physicians are lobbying to restore their central role in consumers’ health care. My previous posts on the medical home concept further document this movement. The ACP offers a sound policy approach that all the Presidential candidates would do well to heed. Taken together, they could set the US on a more productive health care path. But the barriers for some of the strategies are mighty formidable; specialists could balk about turf issues, the health insurance lobby (AHIP) would work to preserve their role in the system (and their layer of administrative costs, which are recorded as revenues to the companies), and of course patients who must take more responsibility for their own care. Finally, the form that universal access would take — single payer or pluralistic — is a political hot potato. The pluralistic approach would gain more traction, but comes with more administrative costs (think: AHIP member revenues). Still, these are noble benchmarks and worthy of pursuit.

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