Cutting Costs and Preserving Quality

November 24, 1993|By MICHAEL E. JOHNS

Most of the reaction to the Clinton administration's proposal to reform our health-care system has centered on its costs. These will be substantial and will require continuing assessment. But equal attention must be paid to the foundation of our health-care system -- its quality.

Increasingly, health-care services are described as commodities, and health-care workers are described as cost centers to be managed, rather than as highly skilled people to be supported in their devotion to disease prevention and to the care and comfort of the sick. Cost centers and commodities don't cure disease -- people do.

Every day, thousands of dedicated health professionals help their patients to face difficult decisions about their care and the quality of their lives. In recent years cost-managing formulas have been imposed on these critical decisions by third parties such as insurers. These formulas have led to wide spread frustration among health professionals and anxiety among patients who worry whether a medically necessary test or treatment will be denied.

Without proper safeguards, the proposed health-care reforms could easily lead to a vast shift of control over critical care decisions from doctor and patient to profit-driven, risk-managing enterprises.

The best safeguard of quality and cost-effectiveness is the proper education and training of our nation's health professionals and the availability to the public of clear and accessible information about maintaining good health and seeking appropriate medical care. Academic health centers provide this foundation for our health-care system and need to be full partners in any new configuration.

Academic health centers are America's primary resources for lifelong learning by doctors, dentists, nurses, pharmacists, public-health professionals and others. Some, like Johns Hopkins, also develop new knowledge and new technologies to improve health and provide more effective care. Many are recognized worldwide as centers of excellence and innovation in health-care delivery.

Because their educational and research missions must be closely integrated with their patient-care missions, our academic health centers cannot compete on a cost-per-patient basis with many community hospitals, small teaching hospitals, clinics and HMOs. That's because teaching and research involve both added costs and unavoidable inefficiencies.

Being at the frontiers of biomedical science requires intensive preparation, appropriate facilities and stable resource commitments. Forced to compete strictly on a cost-per-patient basis, our academic health centers will not survive. The engines that drive America's pre-eminence in biomedical science will wither, and the quality of American medicine will decline.

The Clinton plan acknowledges this and proposes to support the missions of the academic health centers. But this support already is the target of cost cutters. And since the constituency for this funding is diverse and not politically vocal, there is a great risk that funding for these centers and their critical functions will be compromised. This must not happen.

Our nation's commitment to improving human health is unequaled. If we are to maintain it we must realize that cost is a serious concern, but quality is paramount.

Michael E. Johns is vice president for medicine and dean of the medical faculty at the Johns Hopkins University School of Medicine.

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