Part 1: How has the Traditional Healthcare System Evolved?

Executive Summary

The ever evolving healthcare system will see significant changes coming in the future. Complementary (CAM) and integrated medicine will continue to grow as major players in how Americans treat medical problems. CAM is defined as a “ group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicineconventional medicineMedicine as practiced by holders of M.D. (medical doctor) or D.O. (Doctor of Osteopathic Medicine) degrees and by their allied health professionals such as physical therapists, psychologists, and registered nurses....“The Complementary medicine" refers to use of CAM together with conventional medicine, such as usingacupunctureA family of procedures that originated in traditional Chinese medicine. Acupuncture is the stimulation of specific points on the body by a variety of techniques, including the insertion of thin metal needles though the skin. It is intended to remove blockages in the flow of qi and restore and maintain health. in addition to usual care to help lessen pain. Most use of CAM by Americans is complementary. "Alternative medicine" refers to use of CAM in place of conventional medicine. "Integrative medicine" combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness. It is also called integrated medicine.” (National Center for Complementary and Alternative Medicine (NCCAM)) As healthcare costs continue to rise from a variety of things like hospitals creating monopolies in the marketplace by buying out local medical labs and private practices, the rise in the number of people enrolling in Medicare and Medicaid, (with no legal option for Medicare to negotiate the price of prescription medicine), and more specialist seeing patients, people will seek CAM options for care. Also, patients will find the holistic approach used in CAM where the patient-doctor relationship is prioritized in stark contrast to the quality of the patient-doctor relationship in conventional medicine where patients may find care compromised as the result of a doctor shortage and the fear that managed care organizations are more concerned with the bottom line than their well-being. The Kotsanis Institute is a cutting-edge integrated medical facility that provides exceptional care and education to its patients. As a board certified otolaryngologist and otolaryngic allergist, nutritionist, and surgeon, Dr. Kotsanis combines his 27 years of personal clinical experience with the latest scientific information about emerging technologies to deliver outstanding patient treatment and care. He also incorporates evidence-based research from many disciplines and many countries. The Institute also provides a vast array of educational items and teachings for the general public and other physicians, as well as being a leader in Insulin Potentiation Targeted Low Dose Therapy (IPTLDSM).

How has the Traditional Healthcare System Evolved?

What was the system like in the past?

According to the article “Improving Health Care: A Dose of Competition”, the present day health care systems have evolved away from the family physicians of the twentieth century, where people chose the doctor they wanted to see and there was little involvement from the insurance company. In the 1980s and early 1990s, managed care began to take over as the main form of health care. The report states, “In 1980, the overwhelming majority of the population was enrolled in an indemnity insurance plan and managed care organizations (MCOs) accounted for a small percentage of the market. Fifteen years later, these patterns had reversed, and various managed care offerings accounted for an overwhelming majority of the insured population.” (Federal Trade Commision and the Department of Justice)

What is the system like now?

“but the cost of that private insurance — and therefore those subsidies — will be much higher than if the same people were enrolled in Medicare at an earlier age… because Medicare buys health care services at much lower rates than any insurance company. Thus the best way to lower the costs seems to be to bring near seniors into the Medicare system before they reach 65. They could be required to pay premiums based on their incomes, with the poor paying low premiums and the better off paying what they might have paid a private insurer. Those who can afford it might also be required to pay a higher proportion of their bills — say, 25% or 30% — rather than the 20% they’re now required to pay for outpatient bills.” (Brill)

As people became more frustrated with managed care organizations the “Improving Health Care: A Dose of Competition” report goes on to state that:

“New forms of health care delivery have emerged, including preferred provider organizations (PPOs), point-of-service (POS) plans, and "concierge care." PPOs involve a broad network of providers, who agree to accept discounted FFS payments in exchange for participating in the network.³³ POS programs generally require consumers to select a primary care gatekeeper, yet allow them to use out-of-plan providers for services in exchange for a higher co-payment. Some physicians who seek to avoid managed care entirely have begun concierge practices, where they provide personalized care, including house calls to patients willing and able to pay out of pocket for health care costs.³⁴ The price of these options vary, with consumers facing greater out-of-pocket costs if they select less restrictive options.” (Federal Trade Commision and the Department of Justice)

What will it be like in the future?

Lisa Zamosky, introduces some of the changes coming in the future for healthcare. Under the Patient Protection and Affordable Care Act (PPACA), Zamosky’s report states:

• “New coverage options. Health insurance exchanges will provide a marketplace where small businesses and people who don’t get health insurance through their employer can shop for plans. The exchanges will offer the full range of private and public health insurance options available to them in their state.” (Zamosky)
• “Help paying for coverage. For people making $43,000 or less, or families of four making less than $88,000, the government will subsidize premiums -- the monthly payment you make to insurers for coverage -- for health plans purchased through health insurance exchanges. You’ll pay anywhere from 2% to 9.5% of your income for health insurance, and the government will pick up the rest. Reduced copayments, coinsurance, and deductibles may also apply to assist with coverage cost. Also, the new law states that the cost of premiums can be no more than three times as expensive for older people than for younger people.” (Zamosky)

“A comprehensive review of 25 surveys of physician practices and beliefs regarding five commonly used CAM practices-acupuncture, chiropractic, homeopathy, herbal medicine, and massage-found that about half of the surveyed physicians believed in the efficacy of these five CAM practices.56 This study found that a significant proportion of conventional physicians were both referring patients to CAM practitioners and/or offering some of these CAM treatments in their practice.” (White House Commission on Complementary and Alternative Medicine Policy)

Also, in section 2706 of the PPACA, it states that “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.” This language allows for coverage from licensed or certified CAM providers. Therefore, it is likely that in the future of conventional healthcare, the usage of CAM will increase.

Furthermore, as healthcare continues to evolve it is not unlikely that new programs will be proposed. It is critical that future costs are considered and controlled. The following examples show predictions are not always accurate. Elwood states in “The Future of Health Care in the United States”, that, “Projecting future costs never is an easy task, but if history is any guide, it is worth noting there is a tendency for advocates of new programs to underestimate what eventually will transpire…In 1988, home care costs under Medicare were projected to be $4 billion. Instead, they were $10 billion.” (Elwood) In “Medicare Looks Like a Government Program Run Amok,” it says “After President Lyndon B. Johnson signed Medicare into law in 1965, the House Ways and Means Committee predicted that the program would cost $12 billion in 1990. Its actual cost by then was $110 billion. It is likely to be nearly $600 billion this year.” (Brill)

Sources:

1. http://nccam.nih.gov/health/whatiscam
2. ^”Under the fee-for-service method, doctors and hospitals got paid for each service they performed. There were no limits on their treatment decisions; doctors or hospitals could order as many tests as they felt necessary.” (Managed Health Care vs. Fee-For-Service) http://www.faqs.org/health/Healthy-Living-V2/Health-Care-Systems-Managed-health-care-vs-fee-for-service.html
3. ”The different types of fee-for-service include indemnity plans and reimbursement plans. In an indemnity plan, the insurer sets an amount that it will pay for a specific medical service. In a reimbursement plan, the patient must pay all fees up front and then file claims to be reimbursed by the insurer.” (Managed Health Care vs. Fee-For-Service)
4. http://www.justice.gov/atr/public/health_care/204694/chapter1.htm#1
5. http://www.webmd.com/health-insurance/features/health-reform-summary-benefits?page=2
6. http://www.webmd.com/health-insurance/features/health-reform-summary-benefits?page=2