Harvard Policy Experts Recommend Steps for Improving Health Care

The latest issue of Newsweek includes comments from seven experts from Harvard University on specific problems with the U.S. health care system and recommendations to address the issues.

Summaries of their comments appear below.

An expansion of health insurance to all U.S. residents to improve access to care "would actually slow the growth in health care spending because people who become seriously ill ... wind up receiving costly medical care, subsidized by society, even if they are insured," Katherine Swartz, a professor of health economics and policy at the Harvard School of Public Health, writes.

According to Swartz, the problem with the employer-sponsored health care system "is that globalization is forcing American companies to become more competitive in what they pay for labor." She adds that employers "increasingly resist paying more than a defined amount for health care" and that "most cannot continue to pay health costs that have doubled in the last decade."

Swartz recommends that the U.S. examine the Dutch health care system, which "uses a combination of premiums and taxes to finance health insurance for everyone."

"Too often" minorities in the U.S. "lack insurance coverage, live in poor communities, experience language barriers and face subconscious biases of health professionals -- factors that contribute to unacceptable disparities in care," according to John Ayanian, a professor of medicine and health policy at Harvard Medical School and a physician at Brigham and Women's Hospital.

In response, leaders in all communities must seek to "root out the reasons disparities persist for major illnesses and develop effective partnerships to eliminate them," Ayanian writes.

The Medicare prescription drug benefit "has helped many afford their medications," but "it won't achieve its original goals unless the new Congress and administration fix a few glaring defects," Stephen Soumerai, a professor of ambulatory care and prevention at Harvard Medical School, writes.

According to Soumerai, the elimination of the so-called "doughnut hole" coverage gap in the Medicare prescription drug benefit would "improve health and might actually reduce overall expenses by lowering hospitalization costs."

Medicare also should "automatically enroll the three million to four million near-poor individuals who are already eligible for very low-cost drug coverage," Soumerai writes, adding, "Reaching them is as easy as looking up their tax and Social Security information."

Some physicians have raised concerns that quality-of-care report cards "will impede professional efforts" to improve care, but "repeatedly we see that when poor quality of care is made public, providers intensify efforts to improve it," according to Arnold Epstein, chair of the Department of Health Care Policy and Management at the Harvard School of Public Health and a professor of medicine at Harvard Medical School and Brigham and Women's Hospital.

Epstein writes that, although "work must continue to improve fairness and accuracy, ... shedding sunlight on medical practice is unquestionably healthy medicine for patients."

"Experts believe that, if hospitals and doctors used" EHRs, "they could vastly improve the quality of care and reduce costs," but progress of implementation "has been slow," David Blumenthal, a professor of medicine and health care policy at Harvard Medical School and Massachusetts General Hospital, writes. He adds that many small physician practices and hospitals "are balking" at the high cost of implementation of EHR systems and have raised concerns about whether "EHRs will disrupt their work and increase malpractice liability."

The U.S. "will eventually catch up" to other nations that have implemented EHR systems, and "patients can speed the process by avoiding doctors and hospitals that stubbornly resist the Information Age," Blumenthal writes.

"Our society needs to do a better job of recording and aggregating pertinent information from those millions of people" who have a "new test or treatment that has not been systematically compared with other options," according to Barbara McNeil, chair of the Department of Health Care Policy at Harvard Medical School and a professor of radiology at the school and Brigham and Women's Hospital.

She writes, "The effort must be rigorous and transparent," adding, "It will cost a substantial amount of money, but it will benefit everyone -- patients, doctors, employers and insurers."

"Payers and regulators need to balance the competing goals of curbing the growth in drug spending and promoting innovative treatments," Richard Frank, a professor of health care policy at Harvard Medical School, writes.

He adds, "All parties, government and private, should agree that insurance coverage will be linked to the demonstrated value of expensive new medicines," and "Congress should develop legislation allowing the FDA to promote competition among biopharmaceutical products when their patents expire, in a way that continues high standards of safety." In addition, Medicare "must be prepared to negotiate prices with drug companies," he writes (Newsweek, 12/10).