I recently attended the MBAA International meeting in Chicago. One of the member groups of the MBAA is the Business and Health Administration Association (BHAA). The BHAA conducted a number of sessions on a wide variety of subjects that presented many interesting discussion topics. Two that I found to be most fascinating were trying to organize responses to national natural tragedies, and the truncation of outcomes associated with health care reform.
The session on Social Justice and Sustainability contained a presentation given by Dr. Vladimir Krcmery of St. Elizabeth University. He spoke of his experiences in providing assistance to Haiti after the earthquake disaster. After this session, a number of folks who have had international experience with disaster relief, got into an informal discussion of the many difficulties that they encountered with foreign governments and agencies. My good friend Dan West was in this group and he made the observation that the people in higher education could probably develop a much more efficient relief model by working through university systems throughout the world. Dan and some of the others lamented that they frequently ran into governmental roadblocks and were coerced into paying “fees” for being allowed to bring aid into some countries. Resistance is also sometimes offered by local physicians in the besieged countries who see outside or foreign physicians as being competitors who are taking away their business. A proposed solution is to use universities in the countries needing assistance as centers where aid and supplies could be sent for much more efficient distribution. Many universities and colleges in the United States have established relationships through faculty and student exchange programs with numerous universities throughout the world. These relationships could easily become the cornerstone upon which this model would be developed. I think that the ideas that were discussed have great merit and should be pursued.
A second topic that I found notable at this conference was the short sightedness of our current health care reform legislation. Once again we seem to be primarily focused on costs and payers and not on delivery and outcomes. The reality of underserved populations in rural and inner city areas, largely due to a lack of providers, has been dealt with in a very inchoate manner by the health care reform legislation. To address this oversight a number of interesting proposals were put forth. Among these was the expansion of the role of public health in providing health care delivery. The Public Health System in the United States has largely been relegated to record keeping, education, immunizations, and many other tangential activities that the main stream delivery system would rather not deal with. The consensus of the conference was that public health needs to be integrated more fully into provider delivery activities. This integration was proposed as a solution to close the access gap we have in our underserved areas. I would propose that this integration become part of our new health care reform.
Along with the expansion of public health, I would also suggest that health care reform needs to look at expanding the use of provider extenders. A specific example would be the role of the dental hygienist. One of the more problematic chronic health issues in the United States is diseases and conditions related to poor oral health. These issues are particularly prominent in some segments of our childhood population and in the elderly. Again, access has been identified as the prime reason for the problem. Using a paradigm based upon the nurse practitioner model for dental hygienists would allow them to go into long-term care settings and provide oral health evaluations and services that are currently not being performed. Similarly, having dental hygienists in public health venues would greatly increase the number of children who would receive attention to their oral health.