Value is the heart of health care.
Subject: Health care industry (Management)
Medicine (Practice)
Medicine (Management)
Author: Hixson, Ronald
Pub Date: 03/22/2010
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2010 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Spring, 2010 Source Volume: 13 Source Issue: 1
Topic: Event Code: 200 Management dynamics Computer Subject: Health care industry; Company business management
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 222558227
Full Text: [ILLUSTRATION OMITTED]

Almost 100 years ago, there was a challenge issued to the Rockefeller Foundation's Board of Directors: "If science and education are the brain and nervous system of civilization, health is the heart" (Ratzan, 2008). This led to the development of public health and a commitment to the growth of health care and medical research. That challenge was made by Frederick Gates (1853-1929), an American philanthropist, businessman, and major figure in the Rockefeller interests, who spearheaded the endowment drive that created the University of Chicago.

Today, Bill and Melinda Gates (no relation to Federick Gates) have created a foundation to establish even more global health care initiatives and services. Ratzan has argued that it will take more than one foundation to battle the challenges we face in reforming health care in America.

He argued that Congress must hear the voice of America. Ratzan expressed regret that the health care reform movement is only viewed as an economic issue rather than a virtue and investment issue. He shared the idea that health care offers a value to society that more than pays for the financial burden, and health care is a value to the future because it helps heal the sick, returns people to work, prevents deaths, and prolongs the lives of millions of Americans.

While values are important in life, there is no consensus as to what those values are. While health care leaders and practitioners may reach a consensus about core values in the practice of health care, there are differences and tensions about how these values should be put into practice and which values should receive primary emphasis (Nelson, Janzen, Trainor, Ochocka, 2008, p. 192). Studying the history of values in mental health community programs points out that many self-help organizations during the 1970s saw their programs as an addition to traditional health care treatment (medications and talk therapy). They would argue that their self-help programs (Recovery, Inc., Schizophrenics Anonymous, and GROW) had an essential value for the patient and mirror the underlying reasons for self-groups such as Alcoholic Anonymous and Narcotics Anonymous (Nelson, et, al, 2008, p. 193).

To those who have deep pockets, the value of the dollar means their corporation gains millions and sometimes billions in government contracts or obtains the right licenses to do business in various states as required by a board of directors. Having your message read by the president or your congressional representative can have a value. Having the president quote someone in his State of the Nation speech can have a value. Having a steady job provides a worthy lifestyle. Good health is an enviable position to be in, as is having a lot of money in the bank. Wishing for a disease- and disorder-free society is a worthy goal but probably not very realistic because there are so many diseases and disorders that are not fully understood and for which there is not a very satisfactory treatment program available at this time. However, there are goals that may be easier to reach, like losing weight, eating a better diet, and getting more sleep. The fact that people view mental health issues different than medical problems is inherent in many cultures. There is a certain stigma that causes people to look for medical advice for depression instead of talking to a therapist. While the most effective way to treat depression is a combination of medication and talk therapy, many doctors will provide a prescription and not refer the patient for therapy. This is one of the dilemmas of mental health practice. The practitioners know the value of good mental health but are not always effective in sharing that message to their communities.

Some of the values people place on health care are related to costs and personal experiences. If a person is going to lose their life due to a disease, then treatment has a higher value to them than preventive care, which may have a higher value to those who are without a disability. People who are free from major illnesses or disorders have a different take on the cost of health care. The same is true when considering the cost of having mental health services as part of the policy. Some people have chosen not to have that benefit because they do not believe they are or will have issues. Another reason might be their own experiences or the experiences of someone they know who has been treated by a psychotherapist. Not all experiences are good, and not all therapists practice the same way. Some mental health organizations emphasize peer support in developing value consciousness in practice. Others offer drop-in programs, while others stress education and advocacy. Research suggests that there are a number of value dilemmas in the practice of mental health services and offer future directions in research, policy, and practice (Nelson, Janzen, Trainor, Ochocka, 2008).

The meaning of an object, a service, and a lifestyle, changes over the life span of an individual. A good job, money in the bank, and having lots of energy are qualities valued by many, but these often have greater meaning later in life when you are living on a fixed income and your body is wearing down. Over time, body parts become infected with diseases, they may become injured or strained. Inadequate sleep, a poor diet, and over-indulgence can create health problems. Being disease-free is valuable to an individual because it allows one to work, study, and play without impediment. Having a health insurance policy--without huge deductible--can be valuable when you enter the hospital or need medicine because many people do not save for the need of that deductible.

Not everyone shares similar beliefs and priorities, and people debate their points of view. The Internet has a multitude of Web sites that offer opinions about the social and economic reforms in America today. This can be valuable for a number of reasons. First, it encourages more dialogue. Secondly, there is a presentation of an issue that may be similar to another but when presented a second time seems to make the point clearer for some. Third, repetition suggests that many more people are sharing similar views. This is a contrast with the polls that are generated by politicians, think tanks, and news organizations. A fourth reason why dialogue is valuable is that any social change or reform movement is given life by the voice of the people.

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Determining the value of health care is difficult for companies to understand. Corporate leaders view health care as an expense, a necessary employee benefit, and it is viewed as something that does not add to the value of their investment dollars. The social reform movement has a hard sell in turning investors into social workers. The argument that must be made is one of long-term investment. Investors are willing to put money into a stock market because they realize the value of stock is very likely to rise over time. As stocks fall, they provide challenging opportunities for good buys. For most investors, the value of their portfolio (hopefully) rises gradually over time. Health care is also a long-term investment, and it is also a safety net. Businesses buy safety nets all the time in the form of fire, flood, and life insurance. A safety net provides some protection against catastrophes.

An illness can be a catastrophe to an individual and their family. For an employer, the loss of a valuable employee for a few days, weeks, or sometimes months can severely hurt a business. Employee illness can delay business shipments, slow production and customer service, and add costs like hiring temp employees or training others to fill the position. If an employee does not take enough time off to get well, then they may never recover fully enough to do all those tasks that their jobs required. That adds stress at work for the employee and the employer.

Smart health care plans will offer low-cost (or even no-cost) copays and deductibles in areas that make an impact. Follow that up with a good medical management program, access to a great network, and wellness incentives. Results pay off. For example, a recent study by Millman proved clearly that plans providing diabetic patients free medication enjoyed a higher return--some 89% of the diabetes on their plans were compliant in taking their medication versus the standard of only 60%. That equals savings (Andes, 2009).

This argument implies that savings is a value. In this illustration, the difference between 89% and 60% percent is 29%. That is significant savings when you consider the 'fact that medication, diets, exercises have a value to a patient only when they are compliant with treatment. When they fail to be compliant they get sicker, get on additional medications, and undergo more procedures than if they had been compliant. Therefore, the value is in reducing medical, allied health care services, testing procedures, and medication trials. In addition, if a person is compliant, there is the hope of recovery and a chance at feeling productive again. That has value to the individual. There have been a number of studies on how health care reform can turn more towards a value-based system (Porter, 2009):

* Prioritizing alternative ways of testing current prevention and treatment of Parkinson's Disease (Van der Welt, 1995)

* How women prioritize health care services for mammography screening as compared to other illness threats (Meischke, 1998)

* How decisions are prioritized for funding and services for specialist health care for people with learning disabilities (Greig, 2000),and how people overcome the stigma and discrimination of mental health services (Pinfold, Byme, & Toulmin, 2005).

But it takes a combination of education by the providers, access to lower-cost care, and a patient assuming responsibility for their treatment and recovery.

Justice is something that Americans value. The legal profession is an industry that develops and promotes quality legal professions. The judicial system was created to mediate and interpret the law. Framing value in terms of justice can be a powerful argument. One example is, "It is not fair to have people turned away from medical services and medications because they have no insurance or sufficient income." Framing these issues in a different light might make a more powerful statement: Depriving a child or an adult of a tooth extraction (with a cost around $100) could have prevented the spreading of an infection to the brain where two emergency surgeries, and six weeks in the hospital cost the government over $250,000 (Crowley, 2008).

Other countries have struggled with the issues of universal health care. In Europe most people have health insurance. The Dutch health care system has four principles of service: necessity, effectiveness, efficiency, and individual responsibility.

(Ratzan, 2008, p. 206) In addition, Ratzan points out that Norway stresses the severity of condition as well as five priorities:

1. Emergency care

2. Treatment that prevents serious long-term consequences

3. Treatment which prevent less serious long term consequences

4. Treatment with some beneficial effect

5. Treatment with no documented effects (Ratzan, p. 206).

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This list suggests that there are different levels of value that are acceptable to a group, state, or government. Health care leaders must set priorities to set or guide insurance coverage decisions as well as allocate health resources. Government, like any organization working in the market, is in the business of making a profit or reaching a goal and controlling risks. Priorities are used in family budgets, to plan their expenses and revenues. One study suggests that personal responsibility can be a form of rationing (Buyx, 2008). While there is a fair amount of controversy surrounding this concept, it is something that more and more people are talking about as the costs of health care is discussed. In any case, many will agree that the patient should be part of the choices/rationing/gate keeping decisions (Lauridsen, 2007). What may increase the value of such sharing is the increase in trust between a patient and their provider. Without trust, all other issues have less credibility and acceptance.

References

Andes, K (2009). A little value goes a long way. Employee Benefit News. September 1, 2009, vol 23, Iss.9; pg 10

Annas, G. J., (2009). The American right to health. The Hastings Center Report, Sept/Oct, vol 39, Iss. 5; pg 3.

Buyx, A. M. (2008). Personal responsibility for health as a rationing criterion." Why we don't like it and why maybe we should. Journal of Medical Ethics, 34(12), 871-874.

Crowley, M. (2008). Justice as a frame for health reform. The Hastings Center Report, 38, 1-#.

Lauridsen, S.M.R. (2007). The secret art of managing healthcare expenses." Investigating implicit rationing and autonomy in public healthcare systems. Journal of Medical Ethics, London: Dec. Vol. 33, Iss. 12, p. 704. http:proquest.umi.com.ezp.waldenulibrary.org/ pqdweb?did=13957262&sid=11&Fmt=e&clientid70192&RQT=309&VName=PQD

Meischke, H., Anderson, R., Bowen, D., Kuniyuki, A., Urban, N. (1998). Health Education and Behavior. Thousand Oaks: Jun 1996. VoL 25, Iss. 3; p. 383.

Nelson, G., Janzen, R., Trainor, J., Ochocka, J. (2008). Putting values into practice: Public policy and the future of mental health consumer-run organizations. American Journal of Community Psychology, 42: 192201. doi: 10.1007/s10464-008-9191-y

Pinfold, V., Byme, E, & Toulmin, H. (2005. Challenging stigma and discrimination in communities." A focus group study identifying UK mental health service users' main campain. The International Journal of Social Psychiatry. Brookmans Park: Jun 2005. Vol51, Iss. 2; p. 128. http://proquest.umi.com.ezp.waldenulibrary.org/pqdweb?did=87696209l &sid=5&Fmt=2&clientld=70192&RQT=309&VName=PQD

Porter, M.E. (2009). A strategy for health care reform--toward a value-based system. The New England Journal of Medicine. Boston: Jun 9, 2009. Vol. 361, Iss. 2; p. 109. DOI: 10.1056/NEJMp0904131

Ratzan, S. C. (2008). Values and health: Tough challenges lie ahead. Journal of Health Communications, September, 13, 6, pp. 521-522.

Ronald Hixson, PhD, BCPC, MBA, LPC, LMFT, DAPA, has been a therapist for- more than 25 years. He has a Texas corporation private practice and has founded a non-profit group mental health organization where he serves as president and executive director. He has a PhD in Health Administration from Kennedy-Western University, an MBA from Webster University, and graduate degrees from the University of Northern Colorado and the University of California (Sacramento).

By Ronald Hixson, PhD, MBA, LPC, LMFT, DAPA, BCPC
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