Including Public Health in National Health Care Reform.

Posted by:
Commissioner John Auerbach, Department of Public Health

In the last two weeks I had the opportunity to interact with members of the Obama Administration and Congress - as both branches of government engage in preparations for a national plan for health reform. 

Given the extraordinary success of Massachusetts in expanding health insurance coverage to almost 98% of the population, it is not surprising that there is a good deal of interest in how it was done here.  The focus of my discussions was on a particular aspect of health reform - the role of public health. 

Under Governor Patrick and Secretary Bigby, and with the strong support of the Legislature, public health has been an integral part of health reform and in a way that has been of particular interest to the federal officials.   In this blog entry I will mention just one of the ways it is related. 

The first and most obvious is the importance of prevention or, as it is sometimes characterized, the promotion of wellness.  This is equally important to those who are healthy and those who have been diagnosed with a disease, such as diabetes.  We know that most health care costs are focused on the treatment of chronic disease. Health care reform should be all about improving the health status of our residents.  And for it to be sustainable, we have to pay attention to controlling costs. A significant percentage of all health care expenditures are a result of diabetes.  And, we know that certain behaviors - namely eating poorly and not exercising - contribute significantly to the likelihood someone will develop diabetes or another chronic disease. 

So In Massachusetts we are developing new approaches to creating conditions that decrease the likelihood of developing diabetes or exacerbating the symptoms if already diagnosed in order the complement the care given with the expanded insurance coverage.  Our focus is mainly outside of the doctor's office - on improving meals in the schools, helping employers develop workplace wellness programs, supporting local elected officials in their efforts to encourage walking and biking and access to fresh fruits and vegetables in their cities and towns  - just to name a few of the actions steps associated with Mass In Motion. 

We also see the importance of linking with physicians and other health care providers who are relaying important messages to the patients.  That is why we are working with the Massachusetts Medical Society, the American Academy of Pediatricians and a range of health care organizations and providers on our HealthyMass Diabetes Task Force. 

These may all seem like obvious things to do.  But the national officials have indicated to us that they need to see how public health complements health care reform in real and concrete ways - or public health's role may be overlooked as the focus intensifies on the doctor-patient interaction and the insurance card.  So, I have been delighted to have the chance to make the statement that health care reform must I include a robust and active public health component, not just a focus on access to insurance.  Such an approach is key to its ultimate success of improving health while controlling costs.

Let me know what you think.  How can we make sure that public health’s role in health care reform is front and center during this historic and important moment? 

Comments

[Melinda Wallace]

I am impressed with the concept of preventative medicine, not only to save costs, but to save lives. Prevention of Type II diabetes can be achieved by helping treat patients suffering from obesity, poor nutrition etc., yet major insurance companies such as Blue Cross, Blue Shield do not and will not pay for any nutritional counseling or weight loss counseling. Even a single doctor's visit where the primary complaint is weight gain, will not be paid for by Blue Cross, Blue Shield. Because of this, many obese patients won't even mention weight gain to their physicians. I'm hoping that health care reform changes that.