By Janet A. Kirby
Frequently the primary focus of the Affordable Care Act (ACA) has been the reform of the financing mechanisms for health care – health insurance. Whether through private carriers, self-funded programs, health insurance exchanges or Medicaid, the attention has been on how to increase the percentage of the US population that has health care coverage and the funding.
The political debate has been partisan and emotional. What is sometimes lost in the rhetoric is the fact ACA includes a system for increasing the population health of this country. Increasing population health is not a new concept but rather has been a concept held from the very origins of medicine. Hippocrates encouraged physicians to “to look beyond that which ails the individual patient and to consider the contexts in which the patient lives.” This has been the focus of public health.
The systems of primary medical care and public health have not existed in collaboration with each other in modern times.
Medical care is largely problem-based and is focused on the health of an individual regardless of whether the cause is disease-based or injury-based. Public health, on the other hand, has been concerned with creating conditions that allow people to be healthy. In the end both sectors have the concern for an individual’s health as their primary reason to be. Working together in the development of systems that better serve the health of the American population seems to be a win-win situation.
ACA, with a focus on making health care affordable and available, creates an opportunity for these two sectors to be integrated toward a common goal. The two-pronged primary goal of ACA is to make health care affordable and available in greater proportions of our society. Affordability means reduced cost. Reduced cost can be accomplished by developing and sustaining a healthier society. Lowering the cost of and even existence of chronic health conditions is a significant contributor to the goal of affordability. The shift toward sustainability in society in general and as a view of health care more specifically can make the medical-public health opportunity a reality.
The logic behind collaboration is sound, but the real chances of success are presented with substantial issues. Primary of the issues is the fact that medical care is funded primarily on a private basis and public health with government funds. Another issue is the fragmentation of the public health system.
Regardless of opinion in favor or opposed, ACA puts more government funding into the health care delivery system and could present an opportunity to really address serious population health issues like obesity, reduced physical labor, smoking and alcoholism.
In the American Medical Association’s 2002 publication, “Roadmaps for Clinical Practice: A Primer on Population-Based Medicine,” strategies for collaboration between the medical and public health communities are examined, which include: 1) coordinating services for individuals between medicine and public health; 2) care for uninsured and underinsured provided through frameworks; 3) population approach to medicine to improve efficiency and effectiveness; 4) identify community health issues through data available in medical practices; 5) raise awareness of opportunities to serve public health, and; 6) work jointly on policy, training and research to continue the opportunities for collaboration.
There is no doubt that ACA is complex and raises questions as to economic viability. However, from purely the perspective of population health, this is the best opportunity in several lifetimes to change the course of history for the health of our society. That is a good thing.
Janet A. Kirby is an Associate Dean for Graduate and Adult Programs in Springfield.