AAMC Chief Says Country Still Wrestles with Health Care

By Jon Parham

 
Darrell G. Kirch, M.D., president of the American Association of Medical Colleges, talks
about health reform at UAMS.

Darrell G. Kirch, M.D., president and chief executive officer of the Association of American Medical Colleges (AAMC), said those challenges include a growing shortage of physicians and a payment system that gives incentive to being sick.

He called for more team-based care, more community partnerships to deliver health care and more focus on promoting wellness. The AAMC represents all 133 accredited U.S. and 17 accredited Canadian medical schools; nearly 400 teaching hospitals and health systems, including 68 Department of Veterans Affairs medical centers; and nearly 90 academic and scientific societies.

His presentation, “Politics, Ethics and the Possibility of a Healthy Arkansas,” detailed some of the economic, political and health care system realities facing providers and patients following passage of the health reform bill this year. He began by asking the audience if they believed that the health care system had been reformed by the new law going into effect.

“Even the president – even the strongest supporters of the legislation, if you listen closely as the debate went on, their language shifted and they purposefully stopped using the term ‘health care reform’ and started using the term ‘health coverage expansion’ or ‘health insurance reform,’ so we haven’t reformed health care.”

He traced the evolution of the modern academic health sciences center back to the 100-year old Flexner Report that rooted medical schools in academia as opposed to stand-alone ventures. The establishment of the National Institutes of Health, he said, laid the groundwork for significant advances in biomedical research but created a focus on the individual investigator being funded for their work.

Another element, Kirch said, was the creation of Medicare in 1965, which he said established the fee-for-service payment model in health care that persists today. “I’m not saying it’s inherently bad,” he said. “It is part of what drove the growth of campuses like this, but it may leave us today with challenges.”

Americans spend more on health care as a percent of gross domestic product than any country in the world – even with 50 million people not having any health insurance, Kirch noted. At the same time, the nation’s infant mortality rate, life expectancy and other health statistics compare unfavorably with other developed countries.

The health care debate goes on against the backdrop of a country that is deeply divided politically, Kirch said. “I see so many important decisions being sacrificed for political reasons,” he said.

Addressing those myriad issues could involve more team-based models for delivering care through networks such as the UAMS Area Health Education Centers, he said – pointing out that the UAMS AHEC network was widely considered among the nation’s best. The modern health care team could ease shortages of physicians with access to physician extenders in some cases, such as advanced practice nurses or physician’s assistants.

Kirch also called for a refocusing of the health care model “from sickness to wellness.”

“How would you be reimbursed by Medicare if you sat down with me for an hour and discussed my health behaviors?” he asked.

He pointed to one point in the recently passed health reform law that he was involved in drafting which allowed creation of health care innovation zones. These, he said, could be partnerships through entities like UAMS or clinics or hospitals that are allowed to test new techniques and concepts for addressing issues of health care access, delivery and financing.

Instead of viewing health care as a political issue, Kirch proposed seeing reform of the nation’s health care system as more of an ethical issue. One element of ethics is justice, he said.

“You and I both know that as great as medical science is and as great as our cutting-edge technology is that there is great injustice in the health care system. There are haves and have nots,” Kirch said.

Read more analysis of the health reform legislation on the AAMC web site.