Responsibility, Accountability and Authority in Health System Reform

March 17th 2009

 0 comments

Posted by Gil Friedell, M.D.

Friedell Committee for Health System Transformation

 

There is general agreement that the present health system in the United States is broken.  Alternatively, I submit we have never really had a health system in this country.  As I suggested in my January blog, our supposed “health system”-- just like “the old navy”--  never really was.  Ask yourself when the last time was that you or your family had truly coordinated, comprehensive and continuing health care for an illness.  And ask yourself whom you considered to be responsible for making sure you got the appropriate care in the different settings or geographic locations where you received that care.  And did the people in one setting know just what you had been told, or what treatment you had received, in the other settings?  And who was responsible for your follow-up care?  Finally, how was your care paid for?  Were there any barriers to receiving the care which you were advised to have, or restrictions placed on your care, by whatever entity paid for your care?

 

Implicit in these questions are some more basic ones.  Think about the relationship between three important words which appear repeatedly in discussions of reforming the health system, namely, responsibility, accountability and authority.  Who or what has responsibility for providing safe, timely, patient-centered and effective health care services to the public, including preventive care services?  And who or what is accountable for the equitable, efficient provision of those services? Finally, and most important, where does—and where should—the authority reside for the development and maintenance of the health system we all want and deserve, one which supports wellness programs, addresses the underlying, preventable causes of illness, and provides coordinated, comprehensive, continuing care?

 

And as you consider these questions, ask yourself which of the individuals or organizations you thought were responsible and/or accountable for your care really were?  Was your doctor still in charge of your care if he/she referred you to a particular specialist?  Was your doctor consulted or informed about care you received from that specialist?  If you were hospitalized, who made the decisions about your care?  If further care was needed after the hospital stay, who was in charge of making the arrangements?  Who coordinated the types, dosages, and scheduling of any medications prescribed for you? And was there any assistance in paying the bills for this care? To whom did you go if something seemed amiss in your care program?  And finally, who had the authority to address any of your concerns and make adjustments in any aspects of your care?

 

We’ll take a look at these questions and your answers in our next blog.

Comments

No Comments

Post A Comment

Name:
Email:
  Due to spam bots, your email will not be displayed.
Website:
Remember Me:    
Comment:
Enter the Text