Direct practice health care: The solution to nationalized medicine?

In a recent article, The New York Times explored "direct practice," an emerging trend in which health care providers focus on preventative care and personal relationships with patients. In addition to improving the quality of health care, this practice may provide a solution to many of the problems faced by President Obama's health care reform package.

One key aspect of the President's plan has been a $2 billion earmark that he set aside for the development of community health centers. On the one hand, this is outstanding: the community health center program offers medical care to millions who might otherwise not be able to afford it. However, in many ways, it suffers from some of the same fundamental problems as the mainstream health-care system. Big clinics promote factory-style healthcare for maximum profitability; by requiring that doctors see a large number of patients -- sometimes one every 15 minutes -- these companies ensure a steady stream of billable hours. Similarly, with their emphasis on providing standard care to the largest possible number of patients, community health centers make the most of their meager resources. In both cases, the focus is on quantity rather than quality.
A Bronx doctor, Jose Batlle, has streamlined his medical practice through the use of online patient records and prescriptions, moves that enable him to act as his own administrative staff. By lowering overhead, he can decrease his work volume, which increases the amount of time that he has to work with each of his patients. This, in turn, translates into a more in-depth analysis of their health problems, a deeper understanding of their situation, and more attention paid to their medications. In the case of one patient, it meant that her medications went from 15 pills per day to 4, with dangerous drug interactions declining to zero.

Another key issue in the President's health care reform plan is the issue of individual cost. Last week, he stated that he is open to congressional proposals that would legally require every American to get health care. While this would translate into an economic windfall for insurers, it would be far less beneficial for consumers, particularly in the absence of a well-established program to make healthcare affordable. It is all too easy to imagine a populace simultaneously terrified over its lack of insurance and its potential for incarceration, while the government tries to figure out how to process millions of scofflaws whose sole crime is having lapsed healthcare.

This is another area that a stronger focus on primary care could ameliorate. Another doctor that the Times profiled, Lili Sacks, charges her patients a monthly fee of between $54 and $129 for full in-office coverage. While she suggests that her patients get insurance to cover costly or extensive health problems, most of their medical needs are covered for a price that is far below most monthly premiums. Further, by giving patients a single point of entry for all basic care and tests, Sacks' technique streamlines healthcare. By eliminating several layers of bureaucracy, it reduces administrative costs.

The lesson is that better, more extensive healthcare doesn't have to be more expensive; for that matter, universal healthcare doesn't have to translate into a lower quality of service. Through a combination of individual service and a focus on preventative care, patients and doctors can lower bills and improve quality. The next question is how the government can encourage this process.
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