HealthReformOpoly ™

Transformation-Rx focuses on creating 'prescriptions for change' that respond to the evolution of the health sector. The health sector is complex with many systems, issues, and viewpoints that need to be investigated when considering any changes. As an analogy for this changing environment, the rotating 3D cube navigator shown on the left, the idea being that "the complex changing nature of the health sector, as represented by this navigator cube "experience".

. Use the 3D cube navigator (on the left) to explore the set of healthreformopoly articles:
• Move your mouse into the center of the green background frame (to the left) to “drive” and “look at” each of the images.
• As you move the mouse (within the 3D cube frame) you are in “drive mode” — doing manipulation via mouse movement, without mouse clicks. E.g. move the mouse towards any corner of the frame and the cube begins rotating in that direction. The rotation follows you around as you move the mouse, and is faster/slower depending on how close you are to the center of the cube.
• Click on any cube face; it "zooms out", showing you the title of the article. A subsequent single click continues the rotation.
• Double Click on any given face of the cube to 'read that article'. When finished, your browser's "Back" button returns you to the cube navigator.
• In “drive mode” the rotation stops whenever you move the mouse outside of the green background space, and resumes when you re-enter it.

HealthReformOpoly ™

The health industry will continue to be based on private sector delivery of services with a free choice of providers and services being selected (and funded) by the people (except for selected Public Health Services including those provided in public schools, the military health care systems, and the Veterans Administration). In addition the health related finances need to be reallocated from paying for marginally cost-effective health care services to more funding for value-added health promotion initiatives. .

HEALTH REFORM --- Go Where the Money Is ….. and Go There Often

With the current functioning of the health sector industries, they will absorb every dollar that the population is willing to make available. The continual escalation in health spending will not be curbed until the consumers get ‘sick’ of feeding the health sector’s seemingly insatiable appetite for money and take action.

The health reform efforts need to consider bank robber Willie Sutton’s approach and focus on where the money is – and go there often. Many health reform proposals address financing systems with some insurance reforms but they have virtually no focus on the delivery of services where 90% of the costs are generated.

In spending over 17% of it’s Gross Domestic Product (GDP) on health care services, the U.S. is paying almost twice as much as other economies in the world. And ranking about 40^th in the world in terms of mortality measures, the U.S gets marginal results. – The U.S. spends about a third more of its GDP on health Care than Canada does with a public sector health care approach.

As a percentage of GDP’s, developing countries spend about 7% whlie other developed countries spend about 11% -- China spends only about 5% of their GDP on health care. The U.S. government projections for $2.5 Trillion of health care spending in 2010 and almost 20% of the overall GDP by 2019 are shown in the following table:

CATEGORY	2010		2019
	($ Millions)	% of Total	($ Millions)	%of Total
Total Expenditures	$2,569.6	100%	$4,482.7	100%
% of GDP	17.3%		19.3%
Per Capita Expenses	$8,289.9		$13,387.2
Hospital Care	$788.9	32.9%	$1,374.5	33.0%
Professional Care	$797.2	33.3%	$1,370.7	33.0%
Nursing Home & Home Care	$226.4	9.4%	$399.7	9.6%
Prescription Drugs (Retail)	$260.1	10.9%	$457.8	11.0%
Other Medical Products	$69.1	2.9%	$106.4	2.6%

Most economists feel that with the U.S. population spending almost one fifth of the overall economy on the health industry reforms are needed to constrain these expenses. It is also recognized that the demand-side of the equation – the health needs of the population of 300 million people – must be addressed with the people taking responsibility for their own health and only use health related services when actually needed.

While some health insurance reforms are needed, the primary focus -- with a combination of actions at both the state and federal levels -- needs to address the delivery of services where 90% of the costs are generated. There are three fundamental and inter-related aspects that need to be balanced:

1. access - making programs and services geographically available on a timely

basis with adequate levels of financing,

2. quality - assuring delivery of evidence-based services including the

associated outcome effectiveness measurements, and

3. costs - based on reasonable transparent prices for value-added products,

programs, and services.

Health reform proposals focusing primarily on only on the access to health insurance will have limited impact on the cost of delivery of the health care services. A more comprehensive and cost-effective approach would respond to both the health and health care needs of the people with accessible quality services.

Private sector cost control initiatives are essential because the health sector is so and complex and expansive that government actions alone will have limited impact. Some federal legislation is needed to set standards for payments (e.g. Medicare). However, legislation also needs to be put in place on a state-by-state basis where issues like Health Exchanges and Medical Practice Acts can be addressed.

The entrenched health sector special interests - primarily health care providers, health insurers, and pharmaceutical companies -- have become problematic for the economy, in general, and for health reform, in particular. The undo influence of these special interests needs to be checked and redirected through both the private and public sectors. However, the public sector elected 'representatives' seem to be responding to the special interests - not the actual needs of the people.