According to Dr. Robert Field of the Mayes College of Healthcare Business and Policy at University of the Sciences, the $787 billion stimulus package that President Barack Obama signed on Feb. 17 included both short and long-term healthcare provisions.
On the short-term implications:
“The short-term provisions assist people who will have trouble accessing healthcare because of the economic downturn. This includes subsidies for people who are laid off and use COBRA to extend coverage. COBRA premiums can be very expensive. It also includes assistance for states in covering Medicaid costs. Medicaid rolls will likely expand as more laid off workers are thrown into poverty. It also includes funding for care for underserved populations, including the elderly and those living in underserved regions.”
On what it means for the future:
“The long-term provisions are of more strategic importance. They have profound implications for the future of the American healthcare system. One major set of provisions encourages the broader adoption of health information technology. It provides large incentive for physicians and hospitals to computerize their medical records. It also implements penalties in a few years for those who do not. These are in the form of lower Medicare reimbursement. Observers have been complaining for many years that healthcare is much slower than many other industries in adopting IT. For about 20 years, customers have been able to access basic information about their bank accounts through ATMs. For about 10 years, they have been able to access complete information about their investment accounts with financial institutions. Of course, we would hardly want to use banking as the model of an industry to emulate right now. However, it seems odd that most patients cannot access their health information electronically or even schedule appointments online, when they can book airline tickets or hotel rooms this way with ease.”
On the result of changes to information technology:
“Increased use of IT has the potential to substantially improve healthcare quality. Many of the thousand of errors that are made each year result from poor communication among providers and poor coordination of care. IT will greatly help with this. On the other hand, IT will probably not reduce costs. Over the next few years, it will likely cost more to implement than it saves. This is not to say that it should not be encouraged. However, it is to say that we should not expect dramatic savings as the ultimate benefit.
“Greater use of Health IT is likely to further promote consolidation of the healthcare industry. Physicians in smaller practices will need to rely on larger entities to install and support their systems, even with the government subsidies. There will also be a need to link systems so that information can be shared across providers. The structure of the industry, therefore, is likely to change as this initiative moves forward.
On additional long-term implications:
“The other major long-term provision establishes a board to conduct comparative effectiveness analyses of new medical treatments. These will be used to determine which treatments will be eligible for reimbursement under Medicare, Medicaid, and SCHIP. Comparative effectiveness analyses compare new treatments to existing ones in terms of cost and effectiveness. They can result in decisions to deny coverage for new treatments if they do not offer measurable improvements in either respect. This is similar to mechanisms in place in a few other industrialized countries, most notably England
, which has the National Institute for Clinical Excellence (NICE) to advise its national health system. However, in England
, there is a government-run health care system that directly relies on NICE to set reimbursement policy. In the United States
, the effect of the private sector will be indirect. Nevertheless, private insurers generally follow Medicare coverage decisions, and it is likely that they will do the same with comparative effectiveness decisions of the new board.
On the end result to healthcare reform:
“Neither of these long-term initiatives implements broad-scale healthcare reform. However, they may serve as “ice breakers” in that they initiate some elements of significant structural change. They make it easier to implement broader reform down the road, and they would likely each be part of a broader reform package.”
Robert Field, JD, MPH, PhD, is chair of the Department of Health Policy and Public Health at University of the Sciences in Philadelphia. His expertise extends into healthcare law and regulation, health system planning and development, and health policy analysis. Dr. Field recently published a book, "Health Care Regulation in America: Complexity, Confrontation and Compromise" which gives a comprehensive overview of the healthcare system in the United States. He is frequently asked to comment for major newspapers and broadcast outlets on late-breaking developments in healthcare.