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Defining Effective Health Care




In the ongoing movement of health care reform, the most visible players have been lawmakers in Washington, DC, determining the outlook of American health care with two pieces of legislation — the final Health Care and Education Reconciliation Act of 2010 and the Patient Protection Affordable Care Act. Meanwhile, primary care physicians like Richard G. Roberts, M.D., J.D., are ensuring through international and national involvement and patient interaction that changes does not only come from the top down.

Dr. Roberts is a professor of family medicine at the University of Wisconsin School of Medicine and Public Health and a general family practitioner in Belleville, WI. He served as president of the Wisconsin Medical Society and the American Academy of Family Physicians (AAFP). Currently, Dr. Roberts is in his second year of a three-year term as president of the World Organization of Family Doctors (Wonca).

Around the World

In his current role, Dr. Roberts acts as the voice of family medicine practitioners around the globe through representation at the World Health Organization’s assemblies and travels to approximately 40 countries every year. During his visits, he meets with presidents, ministers of health and physicians. He also spends time with young family doctors and medical school students and gathers information about their outlook on the country’s health care system, as well as shadows family medicine providers in their own practices.

Dr. Roberts

“Serving with Wonca has presented a very interesting, informative and inspiring set of experiences, because you’re seeing it on the ground — often in the most difficult circumstances,” Dr. Roberts says. “That’s been a great joy of my professional career and a great insight — visiting people in the trenches and at the same time meeting with global leaders for discussions about health care and what health care systems should look like.”

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Dr. Roberts reports that while no country has created the perfect model, telling details emerge in comparisons. The United States health care system ranks between 32 and 72 in global systems, its position dependent on the ranking’s specific measurements. However, the U.S. system costs $2.7 trillion, or 18% of the nation’s gross domestic product (GDP). Countries like Canada and Switzerland, which are continuously tied at the third ranking worldwide, spend 11% of the GDP on health care.

Dr. Roberts’ conversations with the global business community have also yielded revealing comparisons. According to Paul Grundy, M.D., M.P.H., Global Director of Healthcare for IBM, the company’s costs for employee benefits in Denmark are a fourth to a third less expensive than average U.S. employee benefits with better outcomes and patient satisfaction. As Dr. Roberts explains, 10 years ago, Denmark invested heavily in strengthening an already sizeable population of family medicine physicians. The move allowed the country to reduce its hospital beds by 50% and actually profit based on the cost savings in improved patient outcomes.

“We tend to think of health care as helping people, but that’s not really what effective health care is. Effective health care is built from relationships and having someone you know and trust,” Dr. Roberts says. “A lot of what we see in the U.S. health care system is what I call ‘stranger danger.’ Patients often bounce from one physician to another. These physicians are well-trained and well-motivated, but if a patient has a provider who knows them and whom they trust, the patient will do better.”

Close to Home

Based on his global and day-to-day patient care experiences, Dr. Roberts acknowledges that family physicians are not alone in their frustrations with the U.S. health care system, nor should they be the only voices in the discussion to improve the model.

“What I tell physicians is to take from the experiences of their practice. I think there is a range of places physicians can plug in,” Dr. Roberts says. “An individual physician’s degree of participation is going to be determined by his or her energy level.”

With the development of accountable care organizations, physicians can be instrumental at the local level through participation and leadership in these collaborative groups. State-level involvement is available through physicians’ organizations — such as medical societies — where contributions can be heard by those responsible for making statewide policy. Dr. Roberts notes that there has been a recent increase of state representatives and senators with medical backgrounds. Of the current Congress, 24 members entered public service from the health care industry, including 16 physicians.

“Physicians are and will always be very important in health care systems. We are leaders, and if we’re going to be good leaders, we need to understand what the priorities of the system are and how to help achieve those most effectively,” says Dr. Roberts. “We as doctors enjoy a privileged status because the public trusts that we are doing our best to look out for their interests. If that’s not our overarching goal, then we don’t deserve that trust.”

MD News April 2012


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