In the U.S., we’ve defined immediate access to EMS, police protection and fire department assistance as the expectation. We’ve designated one of the few three-digit telephone extensions as the universal means to access these services in the vast majority of the country. And when you dial 9-1-1, you almost unfailingly get the initial assistance you need. With that call, the meter starts running. If you are in an accident or are very ill, the cost of health-care treatment can ultimately be in the tens of thousands, or even hundreds of thousands of dollars.
I recently read a tweet from my own community that neatly summed up the need for health-care reform: “28 minutes in the ED and 4 years to pay it off.” The common fear of getting sick or injured stems not only from concerns about your health, but also from the debt that will likely accompany the care. There are very few instances in the U.S. in which you can amass such a debt unwittingly or instantaneously. Therefore, a shockingly large percentage of U.S. bankruptcies are due to medical debt.
From the government and payers’ points of view, health-care reform is basically about payment reform. This payment reform is a step in the right direction because more money per person is spent on health care in the U.S. than any other nation in the world, but the system doesn’t always offer good value for the money.
According to the Kaiser Family Foundation, U.S. health-care spending accounted for 16.2% of the nation’s gross domestic product (GDP) in 2008; this is among the highest of all industrialized countries. Despite this higher level of spending, we don’t achieve better outcomes on many important health measures, including infant mortality and life expectancy.
We must determine how to deliver care more efficiently with better outcomes. Anyone who’s ever focused on efficiency can read between the lines and realize this ultimately means finding ways to do more with less. As such, everyone in health care will have to look for ways to make it smoother, more cost-efficient and better for the patient. Access, cost and quality matter.
Efficiency Equals Standardization
Many in EMS hail from the fire service. What few outside firefighting know is that for years there were no universal standards for fire hydrants. Trucks had to be equipped with a number of coupler types, allowing firefighters to attach hoses to a wide variety of fire hydrant designs. Now, most—if not all—fire hydrants are standardized. The need for water to fight the fire didn’t change, but the delivery of the water was made more efficient. Additionally, there’s increased competition between the companies that make the standardized products, leading to a reduction in overall costs.
The same is true for EMS. We used to have massive variations and an absence of standards in the way ambulances were designed and equipped. This lack of standardization was dangerous for the crews and the patients. Today, almost every ambulance’s design is standardized and similarly equipped, ensuring that crews have immediate access to the tools and equipment they need. The care and the efficiency have significantly improved through standardization.
These same types of innovations and standards have been slow to come to health care as a whole. Each system can control standardization within its own walls and adopt best practice protocols, but it can’t institute change in other systems or in disparate information technologies. You may have the best, most comprehensive electronic medical record on a patient from the scene, but it doesn’t significantly impact patient care when it can’t be seamlessly passed to the next caregiver.
Health care was already moving in the direction of standardization because of increased information sharing, but health-care reform and the need for efficiency are going to force regulations to come faster. Standardization is going to come in the form of industry regulations.
Health-care reform will maintain the trend of more with less even when the economy improves. Moving forward, health care will be measured through outcomes, effectiveness and, ultimately, value to those paying for service, whether it’s the patient, third party or government. Regardless of the intrinsic value, very few people in America today can afford the cost of health care, either individually or collectively, unless some common sense and innovation are applied. Even if you don’t favor the present approach to health-care reform, you still have a problem that must be solved—cost.
There was a time when roads were built around hills. Now, materials, equipment and technologies have improved to the degree that it often makes more sense in terms of efficiency and cost to go over or through them. Health care is at a similar crossroads. With reform, we have challenges and opportunities to standardize our roads and make them more efficient, so they connect in ways they never have before. The goal of reform is, and must remain, better care for all in need. JEMS
This article originally appeared in July 2010 JEMS as “National Health-Care Update: The road to efficiency is paved with standardization.”