Wedding Kurat

Foundation, association, and government leaders keep saying that access to care is about insurance. This "access is insurance" focus has wasted the 2010 reform effort for the purpose of restoring access. Access to care requires interactions between patients and health care team members. This requires the existence of local workforce to be available for any hope of access. Access is still lower or missing for most Americans because workforce is lower or missing where most Americans reside.   Leaders immersed in concentrations could assume that access is about insurance. Their web sites and reports promote insurance as the access solution. Where health care dollars and where health care workforce are most concentrated, it is entirely possible that expansions of Medicaid improved access where a few people were able to get insurance and also could engage health workforce and the necessary transportation. But this is only because these concentrations of workforce are supporte...

Health care designs helped rebuild health access 1965 to 1978 via JohnsonCare. Many of the current Red Counties were blue back then but have since switched. Health care designs 1980 under ReaganCare slashed and burned health care in Red Counties as seen in hundreds of closures of small and rural practices and hospitals. Designs 1990 - 2010 have also failed for Red Counties. Health care designs under ObamaCare 2010 to 2017 were worse for Red Counties already getting the least and compromised the most. Out of the Frying Pan into the Fire Health care is only one of many frustrations for those who feel that the established designs are failing. It is likely that Lowest Concentration counties will remain most frustrated by lack of design change. Health care designs 2017 to 2021 are likely to make situations worse for Red Counties. Red and Blue Lowest Concentration Are Similar - The Red Counties are bound together by many similar environments, situations, and determinants of health. They ar...

Evidence basis gets much attention. Unfortunately there is much opinion and assumption that buries the evidence. The pathway to becoming a leader in an association is paved with areas believed to be important with or without evidence basis. Associations are prone to point out the need for evidence basis, but they may be the ones that should be improving evidence basis across leaders, staff, and media. The popular media passed around is a great source for assumptions. Unfortunately works published in major journals need a great deal of improvement also. AAFP has a number of areas for improvement regarding evidence basis 1. Maintenance of Certification is supported despite lack of evidence 2. Pay for Performance and derivatives are supported despite lack of outcome improvement in major reviews 3. Pay for Performance is supported despite the consistent evidence to lesser payment for those serving Americans left behind (where family physicians are 3 times more likely to be found) 4. AAFP...

Rapid chaotic change is what foundations and government and payers have promoted most in health care over the last decade. In the attempt to shake up health care and promote value, core values have been disrupted. Cost, quality, and access have not significantly improved. Costs have increased substantially. Outcomes have not improved. Access has not improved where most Americans need access. Even worse, people have been taught that access is about insurance - not much help when workforce is not available. In many ways what has been done via innovation has been distraction from actually addressing cost, quality, and access.  Keeping Perspective During Turbulent Times was a recent post by Commonwealth. It is quite interesting that those who have engineered turbulent times would craft such a post.  The following is a representation from the perspective of basic health access. The Innovation Bandwagon Takes No Prisoners There is no stopping this train as so many new players are e...