Access. Cost. Quality. Those are three dimensions of a satisfactory health care system, according to Dr. Mark Laitos.

Laitos, who is president-elect of the Colorado Medical Society, a physician in family practice in Longmont, a founder of a health care organization, and a Rotarian, spoke to the Boulder Rotary Club recently about health care reform.

He said serious problems in each of those three areas have produced the current call for health care reform.

“Access to health care is not available to many millions of our citizens," he said. In some cases the problem is financial inability to pay for insurance – and in other cases insurance is unavailable because of existing medical conditions. Many people live and work in places, especially rural areas, where there are few or no health care providers.

In addition, the costs for medical care are rising much faster than other costs, Laitos said. “Between 2002 and 2007, medical insurance premiums rose more than 70 percent. In 2001 alone more than one million people declared bankruptcy because of their inability to pay medical bills."

Further, he noted, there is no cost transparency in the current system – it is simply unclear how prices are arrived at, especially because the necessity to provide emergency care for everyone results in shifting costs from one part of the system to another.

Finally, Laitos said, “Measures of service quality show no correlation with cost to provide services.” Some procedures are effective and some are of marginal effectiveness, but the charges for all are not related to effectiveness. Prices for the same procedure vary from one place to another.

Answering his own question, should the government get involved, Laitos noted that in fact, both federal and state governments are already heavily involved in health care. Tax policies, such as treating employer contributions to health insurance as non-taxable, affect access. Government regulations affect quality of care and transparency. And, of course, direct health plans operated by governments, such as the Veterans Administration health services and hospitals and the provision of in-house medical care to the military.

In conclusion, Laitos prescribes:

Good access provides reliable coverage for all, free from adverse selection for existing conditions, and avoids cost shifting from one class of patients to others. “Universal health care is one way to do this,” he said.

Reasonable costs can result from attention to the comparative effectiveness of alternative therapies, and a change from paying for individual actions (fee for service) to paying for medical results. Laitos suggests that a care organization providing a “health home,” with consolidated record-keeping for every person, is one way to achieve this.

Quality can be enhanced if the initiatives in the system encourage good outcomes, not simply carrying out activities. Measures of health care quality need to be known to all so that informed decisions about health care can be made by patients and their families.

Access. Cost. Quality.

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