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Nita Stika owns CWTD Consulting, a provider of healthcare education and practice management services. She is also an instructor in Lakeland College's healthcare management degree program and is a former healthcare administrator.
Nita Stika sees healthcare as a three-legged stool: cost, quality and access. If one of the three legs isn't in balance, the stool may topple.
"The constant challenge in healthcare is to keep those three factors in balance," Stika said. "If there is an increase in access, the cost is higher and the quality is at risk. If we're trying to keep quality at a high level, the cost goes up and access may go down."
And Stika points to data that says that the legs of the current U.S. healthcare stool are not in balance.
According to the National Coalition on Health Care, in 2008, the United States spent 17 percent of its gross domestic product (GDP) on health care. It's projected to reach 20 percent by 2017.
"That is a crisis," Stika said. "When we talked about how many millions of people are without coverage, I view it as a crisis. It's a crisis when people who have always been employed have lost their job and do not have the income to afford their own individual policies."
Stika said it takes the average person more than three unemployment checks to afford the COBRA benefit, leaving little remaining for life's basic necessities. People get removed from healthcare plans and access emergency rooms for basic care, and the cost is shifted to everyone else. "We're paying for it one way or another," she said.
The CIA World Factbook puts the U.S. at 46th in the world on the infant mortality rate list. Evidence, Stika says, that there is plenty this country can learn about improving quality from other nations.
"My concern is we get so caught up here in the U.S. that our healthcare is the best in the world, and it's not," Stika said. "We could be learning from other countries and what they're doing right. Not all of them are doing everything right, but we certainly aren't doing everything right either."
Stika says any long-term solution has to begin with a reduction in administrative waste and better communication among physicians.
"Physicians don't talk to each other as well as they should," Stika said. "Often, pharmacists have to intervene and say, 'Does your other doctor know you're taking this, because these two medications don't work together.'
"If they're not talking to each other, there's a lot of duplication of service. 'I just had that blood test with my other doctor.' 'Yes, but I want my own results from my own lab.' Is that because they want to make the money, or for their own liability reasons they want to document that they did their own test?"
Adoption of electronic medical records and changes in medical coding - the process of assigning numerical codes to a physician's medical diagnosis or procedure that are used by insurance companies to determine reimbursement - could aid in better communication, Stika said. But the cost of those changes is steep, and history suggests the adoption of new systems is slow.
Stika said any new healthcare program must also account for a population that's living longer and suffering chronic healthcare issues.
"The onset of chronic illness is happening earlier and earlier because we've got the trends with obesity, diabetes, heart disease," Stika said. "Why? Because of poor lifestyle habits and stressors. People are getting sicker earlier, but because of technology, which is also expensive, we're keeping people alive longer. That adds to the cost, too."
Compounding the problem, she said, is a shortage of new prospective physicians and nurses interested in entering primary care.
"If this new healthcare reform does go through and more people are insured, there are going to be volumes of people getting treatment they were avoiding," Stika said. "There won't be enough workers to support the increased need for care."
People don't need to wait for the healthcare industry or government to make changes. Individuals can positively impact healthcare, Stika said, by taking better care of themselves and by educating themselves to make better consumer decisions.
"When we have insurance, we think all I have to do is go to the doctor and insurance will cover it and I won't have to worry about it," Stika said. "When we have a very minimal co-pay of $5 or $10 and we have a sore throat, we'll probably get treated for that sore throat because it's annoying and we don't want to deal with it. But if I've got a $50 or $60 co-pay, I'm more likely to pick up a package of those vitamin C drops and tough it out.
"This debate is also about personal responsibility. We see a lot of people who have not been educated in how to care for themselves. If they get the education they need, they know that if they have an ingrown toenail or a little ache, you don't access the emergency department in a hospital for that."
One indicator of progress would be a reduction in the childhood obesity rate, Stika said.
"If parents who are not taking care of themselves are at least instilling good health in their children by saying, 'No, you don't need that bag of Doritos, and why don't you go outside and toss the ball around instead of playing another video game,' that will teach them to have a healthier lifestyle," Stika said.
"If people are living healthier lifestyles, their healthcare costs are likely to be significantly less."