Putting 'Care' Back in Health Care

Skyrocketing spending, a shortage of primary care doctors, and rising poverty all contribute to the crisis facing the U.S. health care system. But there is good news, write Rebecca Onie, Paul Farmer, and Heidi Behforouz in “Realigning Health with Care: Lessons in Delivering More with Less”. We can provide better health care, expand access to services, and cut costs—by using solutions that already exist.

The key is to learn from successful programs, many of them in developing countries, that have pioneered ways to deliver quality care despite extreme resource constraints, too few doctors, and overwhelming poverty. A prime example of this “reverse innovation” cited in the article is PIH’s Boston-based Prevention and Access to Care and Treatment (PACT) project. Under Heidi Behforouz's leadership, PACT has adapted the model of accompaniment by community health workers PIH developed in Haiti to simultaneously improve health outcomes and reduce the costs of care for high-risk patients with HIV, diabetes, and other chronic diseases.

Published in the Stanford Social Innovation Review’s Summer 2012 issue, the article urges U.S. policy makers to broaden the definitions of product, place, and provider in health care.

“Realigning Health with Care” highlights three U.S.-based organizations that pull from successful models in resource-poor countries that have addressed the undeniable link between poverty and illness. In addition to PACT, the organizations include Health Leads and the Special Care Center. Health Leads, which was founded and led by Rebecca Onie, deploys a corps of 1,000 college volunteers to help doctors, nurses, and other health providers write and fill “prescriptions” for food, housing, heating assistance, and other basic resources. The Special Care Center, based in Atlantic City, N.J., uses community health workers as “health coaches” to help patients achieve healthier lifestyles and manage chronic disease. 

All three of these organizations offer lessons that should be integrated into the U.S. health care system.

First, health care can go beyond simply providing medicine to include learning about and addressing a patient’s environment and access to resources. Will she have safe water to with which to take her medicine? Will he have transportation money for his follow-up visit? Enlarging the definition of the healthcare “product” in this way can open the door to tackling the structural causes of poor health, reducing a patient’s repeated visits and thus lowering costs. 

Second, broaden the “place” where health resources are delivered so that patients can access them easily—in their homes and communities. The reverse is also true. Bringing economic and social resources that patients need into or near hospitals and clinics can help make medical care more effective. For example, PIH operates farms next to clinics so that malnourished patients have ready access to nutritious foods.

Third, expand the definition of “health care providers” to include nonmedical staff—people who know the patient’s culture and community. For example, trained community health workers can distribute food, deliver medicine, and identify illnesses, allowing more specialized staff to concentrate on what they’re trained to do.

The bottom line is that alternative models work: It is possible to deliver high-quality health care at low cost.

Can we apply these solutions to the U.S. health care system? Yes, say the authors. With investments from the private, public, and philanthropic sectors, we can realign “health” with “care”—and transform U.S. health care in the process. 

Read “Realigning Health with Care: Lessons in Delivering More with Less”.
Read an article about "Realigning Health with Care" posted by Boston's NPR affiliate WBUR.