Author Archives: kjb431

Implementing (faith in) Reform

impləmənˈtāSHən/ 

noun

The process of putting a decision or plan into effect; execution.

 riˈfôrm/ 

verb

To make changes in something, typically a social, political, or economic institution or practice, in order to improve it.

To implement healthcare reform is to execute massive systematic change that will improve health, no small charge for any government. (See: Affordable Care Act). But Webster doesn’t mention the most important factor in achieving the implementation of reform…

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 The People!

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We cannot implement reform until we acknowledge and appreciate who drives change, and true reform cannot occur without their buy-in. Any country could come up with the best healthcare system in the world, and it will mean nothing if its citizens don’t have enough faith in the system itself to utilize it.

Here in the United States, we love our freedom. We love it so much that we will kill for it, even ourselves. God help the fool who tells us we can’t eat food past 8pm, or who mandates that our sodas come in smaller containers. But when it comes to that heart surgery to unclog our arteries or that medication to lower our blood pressure, you better believe we have a right to demand it. How do you implement healthcare reform in a country that prides itself on life, liberty, and the pursuit of a Big Mac? How do you create pride, faith, and hope in a system people know they need but spend their lives actively avoiding?

Maybe it’s a case of lost hope, specifically in the ability of governments and corporations to deliver. If people are going to buy into a healthcare system, that system better buy into them. I believe that people want to be healthy. (As students of global health we have to believe that to keep our sanity!) I have to believe more than just the fear of going broke due to accident or illness prompts us to generally agree that having health insurance is a good thing. I am less inclined to believe that Americans have bought into the Affordable Care Act, and it is this lack of faith that is paralyzing.

So how do we create it? Since Americans seem hesitant to learn from healthcare models outside our borders (a big part of our problem in the first place), a look at the Veterans Administration healthcare system proves that creating a system that people value is invaluable to the success of health reform. The VA overcame a reputation of bureaucracy, hospital-centered care, and staggering inefficiency in the 80’s and 90’s to become the largest integrated healthcare system in the US today, recognized for leadership in dispensing information, improving performance, caring for more patients with fewer resources, and setting national benchmarks in patient satisfaction.1 The VA is arguably one of the best examples of a healthcare system absolutely dedicated to servicing the needs of its clients. Not only do vets buy into the system because they are entitled to its lifetime benefits, but because they have faith their healthcare providers have bought into them. The VA was able to enroll 800,000 new clients in 2002 because they created a system that people wanted to be a part of.1

I believe that people value health; It’s about time they valued their healthcare. But change won’t happen until the users believe that it will, and it is faith in the reform itself that ultimately decides its fate.

The proof is in the pudding. Or maybe, in this case, the frozen yogurt. 

 

1Perlin, J. B., Kolodner, R. M., & Roswell, R. H. (2004). The Veterans Health Administration: quality, value, accountability, and information as transforming strategies for patient-centered care. The American Journal Of Managed Care10(11 Pt 2), 828-836.

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Why Can’t We Be Friends?

otter_hug it out
The discussion of public-private partnership is often underscored by a general feeling on the part of the public sector that the private sector is cold and calculating, making decisions founded only on business and profit with no real understanding of the real needs of people. At the same time, there is a general feeling on the part of the private sector that the public sector is grossly inefficient with no real model or strategy in place. I would argue that partnership between the public and private sectors is all too often understood as the high efficiency private sector swooping in to save the low-funded, inefficient public sector. The conversation tends to center around governments capitalizing on the skills of the private sector to build models of efficiency and (let’s be honest here) bring in the money to make it all happen.

So let’s change the conversation.

In the world in which we live, money is power. A man like Bill Gates has the ability to pretty much single-handedly choose what will be the next global health thrust. The Bill and Melinda Gates Foundation pledged $10 Billion dollars in 2012 to support Vaccine Development for 10 years.1 The Danish Government partnered with private companies, including IBM, to develop a technology portal to improve communication within the healthcare industry (eHealth) which has shown to improve health and reduce costs.2 The NIH uses public-private partnerships to find and fund new models for biomedical research.

It is the unique role of the public sector (and also its charge) to embrace this partnership and help drive it toward social innovation that is accountable to the people. Not to markets, not to supply chains, but to the people who are the reason for partnership in the first place. Let us, as public health practitioners, increase our knowledge of business economics, as we will be surely be left behind if we don’t. And let’s push those in the private sector to embrace the fact that a business model is not always the answer. For their charge is not to save the public sector but embrace it as an incredible driver of social change. The public sector has to begin to see itself as such.

The only way that this partnership can thrive is if both parties embrace what they do best without feeling like they are constantly on the defensive and work together to share different strengths, knowledge, and resources to enact real change. The question is not whether a good partnership can exist (there is indeed proof that it can) but if the partnership drives social innovation through the exchange of ideas and values, the shifting of roles and relationships, and the integration of private capital with public and philanthropic support. (We can’t forget the voluntary sector!)

First let’s throw out the stereotypes of the greedy, money-hungry soul suckers (although I think I just figured out my Halloween costume) and the volkswagen-driving, peace sign flipping, burnt-out perpetuators of inefficiency. Businesses can grow economies but they inevitably leave the poorest 10% behind. The public sector often feels powerless to take risks, and can work with the private sector to harness the power of innovation to drive social change that doesn’t leave out that 10% but advocates for it.

Dan Pallotta wants to transform the way we think of giving and change. Although his focus is on non-profits, he lays out a needed paradigm shift in how we think about changing the world. Check it out!

http://www.ted.com/talks/dan_pallotta_the_way_we_think_about_charity_is_dead_wrong.html

 

References

1 Martin, M. H., & Halachmi, A. (2012). PUBLIC-PRIVATE PARTNERSHIPS IN GLOBAL HEALTH: ADDRESSING ISSUES OF PUBLIC ACCOUNTABILITY, RISK MANAGEMENT AND GOVERNANCE. Public Administration Quarterly, 36(2), 189-237.

2Thomas, K., & Wolf, M. (2009). Innovation Strategies for Addressing Today’s Healthcare Challenges: Leveraging Public-Private Partnerships to Achieve Results. International Journal Of Innovation Science, 1(4), 179-190.

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