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                         JeffNEWS, June 7, 1994
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While Healthcare Reform Is Not Really New, Its Current Pace Is
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By Bruce E. Northrup, MD
   Clinical Associate Professor of Neurosurgery,
   Jefferson Medical College

   Healthcare reform is not new. In fact, it has been around since I was
in medical school. Yet, in the past, when changes to the healthcare
system occurred, they were never as radical as originally anticipated.
Now, however, the pace of change seems to be accelerating.

   The current pace is driven primarily by escalating costs and a
sluggish economy. In addition, increased competition among third party
payors in the private sector, often aided by healthcare providers trying
to increase their volume of business, has stimulated change even more
than that expected from government.

   The topic attracting most attention - managed care - is something
that should be dealt with directly. 

   First, issues that physicians can best speak to are those affecting
the practice rather than the cost of medicine. This is because our
training and experience orient us in this direction. Some examples:
rationing of care, limiting access to care and selecting care providers.

   Second, because expectations for a "complete" healthcare system are
so high, costs are difficult to limit. A number of examples come to
mind. Perhaps the most dramatic are from both ends of the life spectrum:
end-of-life-care where outcome is often futile (most health expenditures
occur during the last 30 days of life) and beginning-of-life care where
outcome is often severely limited.

   The issue of wellness is obviously important, but at the same time
complex and riddled with variables, particularly with regard to cost.
Patients understandably desire wellness, but who takes responsibility
for the costs of diseases associated with obesity, tobacco and drug and
alcohol consumption? These are all illnesses where a patient's lifestyle
is often the major factor.

   In a burgeoning medico-legal climate, who should support the cost of
defensive medicine? How can we avoid "minor" fraud in cases involving
workers' compensation?

   In future healthcare reform, access to neurosurgeons may well be more
severely limited than access to other specialties. Thus, instead of
trying to broadly limit costs of health care, making sure any healthcare
plan has proper access and control would be preferable.

   What can physicians do to alter the situation and affect the right
direction for the future? An educational effort must be directed at
physicians to first create an understanding of the managed care issue
and then to stimulate individual practitioners to develop solutions. For
example, national organizations of physicians, such as the American
Medical Association (AMA), have already developed home study courses and
workshops, focusing on negotiation, reimbursement and practice
management.

   The current decisions are in the hands of the lawmakers. We must
speak with our legislators to change our course, advising them of which
plans will work, and which will not.

Editor's Note: Dr. Northrup is president of the Pennsylvania
Neurosurgical Society.


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