Mark’s letter to the editor

Health care machine must pay more heed to patients
Published in The News and Observer, Dec. 18, 2011

Your series “Hearts and Minds” did a great job spotlighting the business of health care. I spent 25 years in that business as a medical group administrator, physician practice management consultant and executive recruiter for health care professionals. More recently I spent a lot of time as a patient: I fought cancer and survived and currently I am battling a rare neurological condition. In reading the series, I found myself asking, “What about the patient?” Although patients receive billions of dollars of services, their side of the story is conspicuously absent in this drama.

Mayo Clinic founder William J. Mayo, M.D., stated “The best interest of the patient is the only interest to be considered.” This does not appear to be the philosophy of the executives at WakeMed and UNC Health Care who were featured in Mandy Locke’s investigative series.

Locke did a superb job of describing the power struggles between physicians, hospital administrators, hospital board members, state officials and community members. But where is the patient in the discussion? Are patients better off with less competition among hospitals or doctors? Will outcomes be better or will the level of population health improve if WakeMed or UNC controls the market?

Bill Roper, head of UNC Health Care, and Bill Atkinson, his counterpart at WakeMed, may feel that the more they control the market the better they can influence quality of care, but health care is practiced one patient at a time. Since we’re all future potential patients, while this debate takes place we need to ask ourselves, “What do we want our local health care system to look like and what should it deliver?”

A health care executive from 25 years ago explained to me that the “The great U.S. health care financial machine is made up of large turning gears” consisting of doctors, hospitals, pharmaceutical and insurance companies and the government. He then crudely described the patients as the “grease” that make the wheels turn. My concern is that the patient’s status has not changed much, and Mayo’s philosophy doesn’t reach from Rochester, Minn., to Wake County.

As a patient, I want the choice to select the hospital and doctor who best fit my needs for the best result. After all, patients are the consumers of health care services. I am not interested in a one-size-fits-all approach with one institution controlling the market and controlling the way my medical care is delivered. Health care reform opens the door to change. Hopefully, that change will evolve into something better for the overall care of the population and better outcomes for the sick, not just more profits and market share for the business players in the system.

Ideally, I would prefer a local system that begins with a goal of better health for the population at a lower cost and an infrastructure built around that goal. This requires all participants in the system to work together for a common goal of illness prevention and better health outcomes. Your series seems to imply that the current struggle between UNC and WakeMed is primarily focused on power and executive egos. Let’s focus more on the outcomes, better health and lower cost structure in health care reform and let’s clean the grease off the patient.

Mark Freifeld

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