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Radical surgery is the only answer

Friday, March 24, 2006
Chicago Tribune
by Cory Franklin a physician at Stroger Hospital

Access to health care for a large number of people has been steadily deteriorating. Those who don't have primary-care doctors travel long distances and wait all day to be seen in an emergency room, where care is expensive and impersonal. Sometimes, the only way for the poor to receive a complete health evaluation is to be admitted to a hospital, a step occasionally dangerous and often preventable. Waits to see a subspecialist are months, and for elective surgery as long as a year. The system does not employ enough people committed to preventive care and management of lifestyle risks in the community.

A snapshot of health care in Cook County?

Yes, but it also happens to describe the state of health care in Great Britain. The dire situation recently prompted the British government to outline nationwide measures to improve access to care and provide alternatives to hospital admission. Now that the race for Cook County Board president is set, both candidates for the general election might want to study a recent report by Britain's National Health Service.

For more than 50 years, British health care has been run by the National Health Service, a tax-subsidized government entity (there is a small private health sector for those willing to pay). Traditionally, the British have been reluctant to give up nationalized industries and the NHS enjoyed the loyalty of the citizenry, as it grew unable to accommodate an aging population and provide modern medical technology. Waits grow longer and the ink redder as NHS inefficiency makes it an anachronism in Europe. Pluralist health-care models in France and Germany, based on a coordination of private providers and government insurance for the poor, have proven more efficient than Britain's massive state-run health-care system. With crisis looming, the NHS set out to revolutionize British medical care.

In Cook County, the 2006 health-care budget is nearly $1 billion, yet the government-run system is plagued with similar problems: an overcentralized model too long dependent on hospital-based medical care. For decades, Cook County (now Stroger) Hospital was the largest hospital in the Midwest, once housing 3,500 inpatients daily. Today, it is only the eighth largest in the Chicago area and cares for 350 inpatients daily. At the same time, outpatient needs have risen dramatically. Thousands wait for colonoscopies, prostate screening and diabetic teaching. Community resources are frequently unavailable for patients who find it inconvenient or impossible to travel to Stroger Hospital.

The British NHS plans to provide primary care and subspecialties in the local community, as well as emphasize preventive care and reducing health-risk factors. This entails employing more private-sector providers, introducing incentives for doctors to keep their practices open at convenient off-hours, expanding the responsibilities of nurses, social workers and personal health trainers and encouraging self-care by teaching patients how to manage chronic illnesses such as diabetes--the same goals Cook County should strive toward.

With long waits and demand for outpatient care increasing, Cook County can not solve its problems without resorting to the facilities and professionals in local neighborhoods. Opportunities for public-private partnerships for routine health care may present themselves in any number of ways. Businesses such as Target and Wal-Mart are considering opening in-store medical clinics staffed by nurses or physician assistants and offering basic tests and low-tech treatments inexpensively and at convenient hours. If these clinics open, by partnering with them Cook County could relieve some of the strain on the overburdened Stroger emergency room. Of the 150,000 annual visits to the county's emergency room, even a modest transfer to private providers would allow the public hospital to concentrate on true emergency care.

Some with good intentions and others with a vested interest in the status quo oppose using the private sector to treat Chicago's poor. There has been a historical reluctance to partner with private care-givers because of past corruption on both sides--remember, this is Cook County. Yet well-designed plans, carefully drawn contracts and diligent ombudsmen would give many residents of Cook County greater control over how and where they are treated than they have ever had before.

Is there an alternative? The county could continue relying on tax increases and realizing greater amounts from the state and federal government. Yet more money is being spent than ever before and the obligation to care for the poor and uninsured remains unmet. The NHS proposals are a reminder that sometimes radical surgery is the only cure. It was, after all, an Englishman named Shakespeare who noted, "Diseases desperate grown, By desperate appliance are relieved, or not at all."



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