AACP Principles to Guide Health Care Reform
The American Association of Community Psychiatrists (AACP) is an organization dedicated to the promotion and protection of the health, mental health and wellbeing of the communities of America. High quality health care services, including psychiatric services, must be readily available if our nation and our people are to thrive. We recognize that the systems developed to deliver services to the population significantly influence health outcomes and the economic health of individuals, communities, and nations.
While it is the obligation of government to ensure the health and well-being of its citizens and to design systems to accomplish this task, the current polarized political environment in which the design must occur may not allow for the application of evidence-driven, rational approaches that are most likely to result in good population health outcomes.
Previous efforts at reform have not fixed all the problems associated with a very costly, fragmented and ineffective health care delivery system. Recently, the Affordable Care Act has expanded care and has demonstrated some useful effects, including some evidence of improved health status among people in the states benefiting from Medicaid expansion. Over 30 million Americans remain uninsured, and the individual health insurance market (the Exchanges) is proving to be fiscally unstable in numerous states with rising premiums, co-pays and deductibles. Across the board, health care costs keep increasing at an unsustainable rate and the nation’s overall health status remains poor with significant health inequities. The administrative costs of the “system” are unwieldy and wasteful. In addition, the complexities and resultant confusion stemming from multiple, divergent health benefit plans remain and nothing has been done to unify the patchwork of private for profit, public/private non-profit and government run services.
It is in this context that the AACP offers some simple principles for a rational approach to health care reform. There will likely be more than one way to incorporate these principles into a comprehensive reform package, but we believe that whatever plan emerges, adherence to these principles will offer the best chance for success in meeting the health care needs of our nation.
Universal Coverage: Providing coverage for everyone benefits the public’s health and ultimately reduces the burden on taxpayers. Health conditions can be addressed at their onset cheaply, rather than the expense of treating late stage disease. In addition, healthy citizens and residents are better able to contribute to economic growth.
Basic health care should be provided to all residents, especially high quality primary health care and prevention services. They must be geographically, culturally and financially accessible for everyone.
Premiums, if required, should be determined by ability to pay: those who cannot afford to pay a full premium should be able to access subsidies to enable their coverage.
Basic Health Plan: The elements of a basic benefit plan should reduce the burden of illness overall and help control costs. Single source of payment reduces administrative costs, encourages holistic health care, supports continuity of care and preventive interventions. These measures will have a positive impact on population health, which will further reduce the costs of care and what individuals pay for health coverage. The development of a basic plan need not limit choice or eliminate private insurance options. Supplemental plans could be available and individuals could decide if they would like to purchase additional coverage.
One essential benefit plan with standard coverage provided to all
Standard prices, reimbursement rates, premiums (graduated or progressive) and deductibles for all covered services and procedures.
A single payer plan similar to Medicare (Private insurance companies manage benefits but do not bear risk and have incentive to restrict services) would be most advantageous
Supplementary plans available on private basis for those willing to pay for more extensive coverage or expedited care
Covered services rationed according to need rather than wealth
Value Driven Care: Investing in services and products that are most effective will improve the health of the population. Eliminating waste and excessive profit will increase the resources available to support and enhance services that protect health. Capping the profits of health care insurers and other contracting entities will reduce the conflicts of interest inherent in competitive profit driven systems
Reduce/eliminate unnecessary administrative expenses: integrate care and resource management
Incorporate evidence based interventions and treatment algorithms while supporting innovation and promising practices.
Emphasis on whole person Primary Health Care, Clinical Prevention and Health Maintenance
Realigned financial incentives to support quality outcomes and preventive care
Increase incentives to treat chronic illnesses and people who use services extensively
Reduce or limit excessive profit opportunities for insurance, pharmaceutical and medical supply companies by allowing volume purchasing and price controls.
Simplicity: Reducing complexity decreases costs and the need for consumers to gamble on the type of plan that will best meet their needs. Benefits that are more comprehensible will eliminate confusion individuals have about what their benefits actually are when they choose a plan, and what additional coverage they may wish to purchase.
One basic plan for all, eliminate multiple confusing choices people don’t fully understand.
Integrate resource and quality functions (more outcome driven, global funding opportunities) and delegate administration to direct care providers
Preventive holistic Primary Health Care: emphasis on health maintenance, protection and promotion: nutrition, exercise, screening, recreation
Ensure that basic needs are met: Food, housing, clothing.
Private insurers may offer supplementary plans to individuals and/or employers
Workforce: Reducing the debt burden of medical providers will decrease incentives to choose potentially lucrative practice opportunities. Greater numbers of physicians will choose primary care specialties, so the system will be better able to meet primary care needs, which will ultimately reduce costs and improve the quality of care. Expanding the number of practitioners, who can care for simple health care needs, will likewise expand the system’s ability to meet population needs.
Medical Education Reform- emphasis on primary care and public service
Emphasize holistic care for physical, mental, developmental and addiction disorders
Medical education finance reform- expand National Health Service Corps (NHSC) opportunities, loan forgiveness for primary care specialties: create incentives to enter primary care, reduce incentives for specialization.
Expand use of non- medical primary care providers (i.e. nurses, PAs, health technicians, peers.