Mayo Clinic has had concerns about U.S. health policy for nearly 25 years, but has traditionally played a low-key, behind-the-scenes role on the national public policy stage. In 2005, however, its leaders established the Mayo Clinic Health Policy Center to “act as the glue and the spur to help major stakeholders in health policy find common ground on proposals to implement fundamental reform.”
Our first major public attempt to bring the key stakeholders together was the 2006 Mayo Clinic National Symposium on Health Care Reform, which was held in Rochester, Minn. You can read the Executive Summary of the proceedings here.
After this symposium, Health Policy Center leaders collaborated with other sponsoring organizations to convene four health policy forums involving key thought leaders to develop solutions for the priority problems identified at the symposium. Topics included:
- Equity: Health Insurance for All Americans
- Improving Effectiveness and Efficiency of Care
- Encouraging the Formation of Integrated Systems
- Effectiveness: Paying for Value
Here is a summary of the recommendations to date, along with a more expansive version.
Mayo Clinic’s primary value is “the needs of the patient come first.” That’s why the Health Policy Center has been working hard, together with a coalition of several sponsors, to gather feedback and include patient perspectives in the discussions. You’ll learn more about that outreach effort in future posts and at our next symposium.
Speaking of that next symposium, Mayo Clinic will take the next step by hosting our 2008 Mayo Clinic National Symposium on Health Care Reform, in Leesburg, Va. next week. Tom Brokaw will be the keynote speaker and will moderate one of the panel discussions. Here’s the agenda, and here is a list of other speakers and panelists. We’re expecting 400 participants representing a cross-section of expertise and interest to be there in person next Monday and Tuesday, March 10-11, 2008.
We’re using this blog and other web tools to extend the discussion to everyone who wants to participate. All of the symposium’s general sessions will be made available live via streaming webcast, and also will be archived for later viewing and listening. I will be live-blogging the symposium here, and we will have an open comment thread available during each discussion for anyone to share ideas and opinions.
If you want to engage in the discussion here on this blog, that’s great. If you’d prefer to write on your own blog and link to the relevant posts here, that’s even better. We accept and encourage trackbacks. To help bring the conversation together, please also tag your posts MayoHealthPolicy08, as this one is.
More details on the symposium, including where to access the streaming video, will be posted here in the coming days. Meanwhile, see the Subscribe to Updates section in the column at right for different ways you can sign up for the latest symposium news.
One Comment
The Mayo Brothers used to have a process for charging patients based on the patient’s ability to pay, by using a “sliding scale”; bankers would pay more for gallbladder surgery than coal-miners. Today, such a process, if done everywhere, might skew distribution of health care resources to neighborhoods where patients have the highest income (think of the density of plastic surgeons in Manhattan).
Nevertheless, having more “out of pocket” payment of health care expenses could provide a market-based mechanism to improve efficiency, effectiveness, and even safety — let people use their own health care purchases to inform the market what is best, from the patient’s perspective. In fact, costs have sky-rocketed over the past 30 years in direct proporttion to the reduction in the percent of health care that is paid “out of pocket”; the percent used to be 30 percent, now it is only 15 percent.
The challenge therefore is how to make “out of pocket” payments (which we know are more effective for improving quality, value, and safety) more equitable (the way the Mayo Brothers used to charge, as on a sliding scale, based on means to pay), while doing so in a way that would “mask” the patient’s actual means from providers (who would otherwise, without such masking, simply hang up their shingles in the fanciest neighborhoods, and take care only of the wealthiest patients)?
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A new method of health-care transaction,called Means-Based Health Care Currency, (which could be directly linked with computers that manage Health Savings Account payment cards that are now coming into use), would be enable patients to choose their health care and pay on the basis of each particular patient’s “day’s wages” (a figure readily obtained from tax returns), while paying each provider based on the “national average” of all consumer’s “days wages” in the system. Any difference between the patient’s “day’s wages” and the national average “day’s wages” would be kept in a central depository. In this way, providers would be “blind” to a particular patient’s means to pay, but could still set a price for their services that they know they would get paid (i.e., representing and translating their prices, which they are otherwise free to set at any level they wish, into a national average day’s wages figure); this would also enable the provider to operate their medical practices and prepare their operating budgets for new equipment, etc. — because they know they would get paid a definite amount for each service performed.
This “Means-Based Health Care Currency System” would also have the advantage of making the transaction instantly. As soon as the patient had the service, using their Means-Based Health Care Currency card (similar to a Health Savings Account Card), the amount of the service (as a function of day’s wages) would be withdrawn from the patients individual account, and the provider, in turn, would be paid immediately a correspoding amoung based on the same “day’s wages” — not of the particular patient, but of the national average day’s wages.
To incentivize consumers to participate in such a plan, their could be a high percent of pre-tax dollars that one could place in their Means-Based Health Care Currency savings account. Thus, because the savings in such accounts would accrue tax-free, even wealthier patients would choose to participate. Moreover, all patients, regardless of income, would be incentivized to find the best value and quality and safety in the market -knowing they keep the savings they derived from good value choices. Equity, value-sensitivity, and means-blinding are all needed for sustainable health care reform
I have a PDF and diagram that explains this procedure in more detail. Feel free to contact me if you would like more information.
walker.randall@mayo.edu.
Randall Walker, MD
Consultant in Infectious Diseases
Mayo Clinic
Rochester, MN
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