A nurse’s vision for transforming the health care system – State of the reform



John Silver, PhD, RN, was not interested in politics or models of health care when he became a registered nurse in 1984. However, after years of listening to fellow nurses comment on poor health outcomes and structural inconsistencies in health care settings, he realized he would have to do more than cure to try to solve these problems.

“Innovating in a dysfunctional healthcare system doesn’t change the system.

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After obtaining a doctorate in comparative studies and founding the five-member advocacy group Nurses are transforming healthcare, Argent, based in Fort. Lauderdale, FL, shared his analysis of the American healthcare model, its flaws, and the potential solution he calls the “New American Model.” Here are some of its main takeaways:

Healthcare is too expensive, with poor results

Health care costs in the United States have increased exponentially in recent decades, but poor health outcomes persist. A analysis Health System Tracker (HST) reported that national health spending rose from $ 388 billion in 1970 to $ 3.8 trillion in 2019, almost 10 times more. HST also found that the amount of national GDP spent on health spending increased from 6.9% in 1970 to 17.7% in 2019.

Despite the increase in spending, the poor health outcomes of Americans persist. HST reports that although death rates in the United States have declined over time, the average national life expectancy is 3.5 years lower than that of comparable countries.

Image: Health system tracker

HST also found that a higher percentage of adults reported their overall health to be poor, and only 8% of adults aged 35 and over received all of their recommended high priority preventive services for cancer, heart disease and other conditions.

Silver says there is a mismatch between how the health care system works and what the public needs.

“This [health care] the system is simply not meeting our social goals for health care.

he proposes several objectives the ideal health system should aim, like equitable access to care, for positive outcomes, cost efficiency and social accountability.

We need to redefine what healthcare means

To achieve these goals, says Silver, we must reinvent our vision of health care.

“In the place of [health care] Being just 300 million individual interactions they’re billed for, what if we think of healthcare as a service we provide to the community? “

The new American model Silver offers would reorganize the current structure of healthcare, shifting primarily from fee-for-service models to regional systems that use data from public academic health centers to deliver the best healthcare solutions for their particular communities.

Silver says this new model would prioritize holistic health outcomes over benefits.

“You take away the incentives for profit. [The new model] would look more like a public service. You need to generate profit, but you don’t need 8%, 12%, or 6%. You just need to be able to generate sustainable profit to be able to [support] new facilities or look at what new services you can provide.

Healthcare leaders discussed the concept of value-based care before. At the 2021 Florida State of Reform Health Policy conference, panelists discussed barriers preventing the transition from fee-for-service models, such as a disconnect between executives and providers, outdated data, and the inability to integrate the social determinants of health into policies. .

However, the COVID-19 pandemic may have been a turning point. Hospitals lost an average of $ 1.4 billion in revenue per day due to declining patient volumes during the pandemic, according to accounting and consulting firm Crowe. Some health experts to say as hospitals want to reduce operational costs lost during the pandemic, value-based care may become more prevalent.

For this model to work for healthcare, payment and administration must change

On the payments side, Silver says the system will move from billing for individual services to payments at intervals, like a utility bill.

“Everyone is going to pay for this system service, which it’s going to be based on now, instead of individual interactions. It will be the provision of primary care services in this region.

Silver says that with more people contributing to this system on a regular basis, whether they are individuals, businesses or local governments, collective health spending will decline. For example, he estimated that Oklahoma, which currently spends 20% of its health care budget, could reduce spending to 8 or 9% depending on the new model.

“Businesses pay a ton of money for their employees’ health insurance. It is money that could be put into wages. [Business expenses are] is also going to be drastically reduced because they will be paying in this service delivery, not for individual interactions.

Image: John Silver

Administrative changes, Silver says, include the creation of regional councils of practitioners – representatives of physicians, public health, emergency medical services, and public policy – to oversee the distribution of health care services and resources. , rather than managerial positions.

He says nurses should also have a central role:

“The idea is to have public health, and in particular nursing, which is the street-level health care provider, interact directly with, for example, public health or public health services. city. They identify health risks in communities. Public health and nursing [should be] work together to determine what resources need to be brought to communities, what they need.

Why the nursing perspective is important

Silver emphasizes the value nurses could bring to the healthcare system.

“Nursing, philosophically, is always centered on the other, the patients. We don’t really have a selfish interest as a profession. Nursing is also the expert in the delivery of health care. Medicine is the diagnosis and treatment of disease, physical therapy [is the expert in] physiotherapy, pharmacy [is the expert in] pharmacy, but nursing has over 120 years of experience in how you actually deliver health services to communities. And we have it thanks to our public health nurses.

The very origins of nursing are to reach out to groups in need of health care. And then we had the nurse practitioner movement [of the 1960s], which was exploding. So the expected outcome is that it’s just going to trigger a lot of innovation – especially for nurse practitioners – in the way we deliver the services needed to populations in need.

Next Steps for a New American Healthcare Model

Silver recognizes that not everyone will benefit from this type of healthcare model.

“Who will be the losers? Hospital administrators will certainly be the losers. Corporations, healthcare companies will not like this plan. Insurance companies are not going to like this plan. But is that what we live for to make them happy?

Isn’t our goal to provide health care to a country? I think that’s the kind of philosophical argument we have.

Silver prepares to speak at the next Integrative Provider Association conference in October 2021. Nurses Transforming Healthcare is currently working with lawmakers in Minnesota to create a pilot program of the New American Model in Ramsey County. Silver says his goal is to gain more public support.

“I sort of work with nurses to build enough mass that we can then afford to publicly present that vision. Every group that I talk to… you need a discussion with them, because it’s not a five-minute elevator sale. Sometimes it takes a continuous discussion for weeks and months to finally get them to the point where they’re like, “Wow, this is the system we need. “



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