RWL Newsletter #105
Greetings from the University of New Hampshire! I’ve just returned from a jaunt up to Portland, Maine, for the annual board meeting of the NNEAHE, the local chapter of ACHE. I am lucky to be an ex officio member – as their friendly neighborhood educator (just like Spiderman, except my superpower is I make other people climb up walls). Being part of a professional organization is really important to your career. I wish I had made a commitment to one much earlier. I learn a lot from my participation, and the learning comes in the form of both formal knowledge as well as tacit knowledge. The tacit knowledge – the informal exchange of ideas, and the socialization effects – are probably more valuable than the formal knowledge transmitted, which is why I recommend membership to a professional organization to my students all the time. ACHE is great if you are in healthcare administration. I’m also a member of HFMA, which is also a great organization if you are involved in healthcare finance. There are many others. I strongly recommend picking on and getting involved.
No theme this week. I appreciate your feedback on the articles - please e-mail, tweet, or comment your thoughts!
(picture above is from the Foss Farm trail in Durham. The trail runs right behind my house. I love taking my dog out on this trail. We haven’t had much snow this year, so the woods are winter stark.)
Read
What: Kaiser Health News, Spurred By Convenience, Millennials Often Spurn The ‘Family Doctor’ Model
https://khn.org/news/spurred-by-convenience-millennials-often-spurn-the-family-doctor-model/
Why: Interesting read about Millennials choosing to use urgent care over a family doctor/primary care manager. I think continuity of care is preferable to seeing a random provider every time you need help. I think that is obvious. In my life, I haven’t had much continuity of care. That was largely shaped by the fact that I moved a lot as a kid, and I kept on moving a lot in my military career. The military health system for most of the time I was in only gave lip-service to the PCM relationship. You typically got whatever provider happened to pull your chart. The best continuity I had was when I worked in a hospital and got to know individual physicians who had taken on administrative duties. If I had an issue, I would just walk down the hall. But I was lucky and didn’t have any chronic conditions that required continuity. Every now and then I would get a sore throat or bang my knee – so drive by medicine was fine. Now that I’m getting older, I think I’d like more continuity. The body doesn’t bounce back as fast, and I am developing this chronic condition known as getting old. My point, though, is I doubt most young people need much continuity of care. And the cost of dealing with most primary care practices is high – in terms of convenience. Membership-style primary care practices (sometimes called “direct primary care”) are nice, but pricey if you are a healthy young person. The explosion of minute-clinics and urgent care centers tell us there is a demand for this kind of care. So while it is obvious that continuity is preferable, it isn’t the only thing that matters. Health systems need to innovate to provide the right care for the right people.
What do you think?
Watch
What: IF 100 PEOPLE LIVED ON EARTH (2 minutes)
https://youtu.be/OQwHNqMapiE
Why: This is just a fun little brain-brake with cool steel drum music. It runs through a bunch of demographics that look right-ish to me. I’m not going to swear by them. Something to think about. As one of the comments said, it doesn’t say why things are this way, just that they are.
Are any of these a surprise to you?
Listen
What: Econtalk, Ed Dolan on Employer-Sponsored Health Insurance (64 minutes)
http://www.econtalk.org/ed-dolan-on-employer-sponsored-health-insurance/
Why: This podcast is based on an article written by Dolan. He is critical of employer sponsored health insurance (ESHI), as am I, because it creates distortions in the pricing of health insurance and thus health care, and it creates this problem of “job lock”. Job lock is when you would like to leave a job, but can’t. Health insurance can cause job lock for people who have chronic, pre-existing conditions. If they leave their employer, they might face a situation where they cannot afford health insurance. One of the strengths of the ACA is the provision against excluding people with pre-existing conditions, though there are other ways to deal with this than a blanket prohibition, as I have discussed previously. Dolan has an alternative solution I think is quite centrist. He calls it “universal catastrophic coverage (UCC)”. This is his description of UCC:
Under UCC, everyone would automatically be issued a policy similar to a conventional Medicare or Medicare Advantage policy, with no premium required, but with an income-based deductible. For families below a designated low-income threshold, for whom almost any medical expenses would be unaffordable, the deductible would be set at zero. For others, it would be set as a percentage of eligible income, that is, of the amount by which household income exceeds the low-income threshold. For everyone, regardless of income, deductibles would be waived on a package of basic primary and preventive services, such as prenatal care and childhood vaccinations.
What do you think?
Thanks for reading and see you next week! If you come across any interesting stories, won't you send them my way? I'd love to hear what you think of these suggestions, and I'd love to get suggestions from you. Feel free to drop me a line by e-mail, or you can tweet to me at @mbonica .
Also, if you find these links interesting, won’t you tell a friend? They can subscribe here: https://tinyletter.com/markbonica
Have a great weekend and do amazing things!
Mark
Thanks for reading and see you next week! If you come across any interesting stories, won't you send them my way? I'd love to hear what you think of these suggestions, and I'd love to get suggestions from you. Feel free to drop me a line by e-mail, or you can tweet to me at @mbonica .
Also, if you find these links interesting, won’t you tell a friend? They can subscribe here: https://tinyletter.com/markbonica
Have a great weekend and do amazing things!
Mark
Mark J. Bonica, Ph.D., MBA, MS
Assistant Professor
Department of Health Management and Policy
University of New Hampshire
(603) 862-0598
mark.bonica@unh.edu
Health Leader Forge Podcast: http://healthleaderforge.org
"I know of no more encouraging fact than the unquestionable ability of man to elevate his life by a conscious endeavor." - Henry David Thoreau