Horizon, Host: Ted Simons

August 24, 2009


Host: Ted Simons

Health Care Reform


  • Bernadette Melnyk, Dean and Distinguished Foundation Professor in Nursing at the Arizona State University College of Nursing & Health Innovation, shares her views on health care reform.
Guests:
  • Bernadette Melnyk - Dean and Distinguished Foundation Professor in Nursing, College of Nursing & Health Innovation, Arizona State University
Category: Medical/Health   |   Keywords: health care,

View Transcript
Ted Simons:
The national debate over health care reform is generating more heat than light, and ideas are hard to hear above the shouting. This week on "Horizon" we take time to listen to what some Arizonans are saying about health care. Tonight we begin our series of one-on-one interviews with Bernadette Melnyk, dean of the College of Nursing and Health Innovation at Arizona State University. Good to have you here. Thanks for joining us.

Bernadette Melnyk:
Thank you.

Ted Simons:
Let me start with just the most general of questions. Is health care reform necessary?

Bernadette Melnyk:
I believe it is necessary, specifically in certain areas. Probably the most important is primary care and providing the access that we need in primary care and preventative services.

Ted Simons:
You've mentioned primary care and access and these sorts of things. Is it the idea that, if we go ahead and make sure the 40-some-odd million who aren't insured become insured, we're going to need more health care providers.

Bernadette Melnyk:
Absolutely. There is a critical shortage of primary care providers right now, particularly in rural and underserved urban America. 70% of Americans right now who are insured cannot get a same-day appointment with their primary care provider.

Ted Simons:
So how do we -- granted, if health care reform succeeds, then you've got a whole new problem here. How do you get health care reform to succeed? How do you get those folks insured?

Bernadette Melnyk:
What you have to do is increase the supply of primary care providers. That includes physicians, nurse practitioners, as well as physician assistants. Most recently we have the news that very few residents getting out of their programs are choosing primary care as a specialty. So nurse practitioners can fill a tremendous gap, in terms of access to care.

Ted Simons:
But as far as a primary -- and I guess nurse practitioner is anyone in the primary care service industry -- is there -- the old idea of a primary care physician was that's the hub and the spokes go out to all the specialists. Does that exist anymore?

Bernadette Melnyk:
We are talking a lot about the increased use of health care homes, So that people receive continuity in their care at one particular place. So for instance, even mental health services, which are in dire need of health care reform in our country, there is a huge need to integrate mental and physical health in primary care settings. All the chronic illnesses that we have in our country hopefully, through very good health care homes, we could be managing folks throughout their problems in one particular place, instead of diversely spreading that across multiple homes, multiple specialties.

Ted Simons:
Why is that diverse spread happening? How did we get here?

Bernadette Melnyk:
Again, it's the way that our health care system evolved. If you think of how physicians have been trained, right now we have physicians not choosing primary care practice because they can make double the income in specialty care. There were a lot of incentives for physicians, for instance, to go into specialty areas. Which again is putting a drain on the number of them that are available to provide primary care services.


Ted Simons:
Do you then do something to soften those incentives? Do you do something that takes a little bit more of the profit motive out of health care? How do you address that?

Bernadette Melnyk:
There is a lot of talk going on right now nationally about incentivizing physicians, nurse practitioners, to go into the primary care specialty. Offering them some type of great scholarship, stipends to go in primary care. And again, we need, when we think about reimbursement, a lot of nurse practitioners are not reimbursed at the same rate as physicians for the same health care services. That is, again, limiting the amount of primary care providers who can be providing good health care services to people.

Ted Simons:
If accentuating primary care providers and getting that particular sector more up to speed or able to handle what will no doubt be a bunch of other people getting into the health care system, if that succeeds, how much -- are we going to be able to afford this? How much money are we talking about here? Could that wind up driving down costs in other areas?

Bernadette Melnyk:
Again, if we put more emphasis on prevention -- I have a great example for you. In 2007, 47,000 Arizonans died. And we estimate that 60% of those deaths could have been avoided with excellent primary care evidence-based intervention strategies. Again, if we catch things earlier in primary care, through good screening, if we manage chronic illness better in primary care settings, that's going to drive down the cost of health care.

Ted Simons: Of the plans you hear about and see out there right now, the kinds of plans a lot of folks are expressing concern over, they are afraid what they have may not be there or those that aren't insured aren't sure how much they are going to be insured, there's a variety of concerns out there.

Bernadette Melnyk:
Absolutely.

Ted Simons:
What makes the most sense to you, from what you've heard? Is it a public option? Is it single pair? What is it? What makes sense to you?

Bernadette Melnyk:
What makes sense to me is the opening of more primary care health care homes, so that would expand access definitively. But in those homes, again, you would have continuity of care across a variety of services. You would have continuity of care for people who have chronic illness. If you think about all the people who are seen in emergency rooms, 50% of those people seen in emergency rooms could be handled beautifully in primary care settings if we had enough primary care health care homes.

Ted Simons:
How do we pay for it?

Bernadette Melnyk:
We pay it for, again, I believe, through a restructuring of what we are currently doing. Again, the cost that we put in to managing all of these chronic illnesses, we could save so much more money if we reimbursed more for primary care prevention services. We'd lessen the amount of costs that we are paying for people who develop these chronic and terminal illnesses.

Ted Simons:
But as far as paying for what you see as a pretty good solution, is it going to be done primarily through the insurance industry? Is the government going to have to take a stronger role here? Again, I'll ask you: How are we going to pay for it?

Bernadette Melnyk:
I think it can be paid with helping people, maybe even providing them with a certain stipend that they get a chance to choose their health care plan.



Ted Simons:
Are you optimistic that the debate going on right now regarding health care reform will result in something substantial? Or is this going to wind up being something watered down that we'll all complain about for the next 10 to 15 years?

Bernadette Melnyk:
I do not believe it's going to be the original health care reform plan that has been put forward. I do think there are going to be revisions to that particular plane. The bottom line is people want access to high-quality preventative and comprehensive services. Again, we don't have that existent by creating again more primary care homes, where you can have a variety of providers, especially nurse practitioners, if they were given full reimbursement by insurers, full credentialing to be primary care 16 providers, we deliver, and the evidence shows this, high-quality care at less cost. So I think there's a lot of evidence-based knowledge that we have that we are not using right now in our health care system.

Ted Simons:
All right. Very good. Thank you so much for joining us, we appreciate it.

Bernadette Melnyk:
Thank you.

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