Riley, M.

http://medicalstudentblog.co.uk

Two primary schools of healthcare arose from within the Ancient Greek culture: Aesculapius, associated with the healing of illness, and Hygeia, associated with disease prevention through lifestyle (Rodriguez, 2009; Atsma, 2008). Aesculpapian models serve to treat patients when they become ill, whereas Hygeian models focus on the creation of health and healthy lifestyles, including hygiene, balanced diet and other healthy habits that help a person to be overall more healthy and need less or no treatment for preventable diseases. Aesculpian healthcare delivery models reflect the vast majority of the current US delivery system, whereas the Hygeian model is more representative of the European healthcare model (Rodriguez, 2009).

Within the United States, there have been many healthcare reform efforts, including the current reform debates that will shape the coming sociopolitical system and furthermore the healthcare delivery within the country. The current majority of the country is based on the Aesculpapian model: treating patients when they become ill. This model provides a system that is based on fee-for-service economics, allowing providers to charge patients and/or insurances for services rendered in the diagnosis or treatment of a disease. However, like many other places in the world, Kaiser Permanente offers a health maintenance organization (HMO) which follows the Hygeian model in attempting to prevent disease and thereby reduce costs through prevention rather than in limiting treatment options (Rodriguez, 2009).

Kaiser Permanente was a novel system developed following WWII that addressed the needs of a community-based workforce (Rodriguez, 2009; KP, 2009). However, the system of prepayment was born in the United States even earlier; in the midst of the Great Depression, Sidney Garfield, MD, joined with Harold Hatch to establish insurance prepayment for care delivered to poor contractors (KP, 2009). However, the institution of the healthcare organization came with WWII and the need to deliver care to the many workers, many of whom were rejected from the draft due to poor health (Rodriguez, 2009), in the shipyards in California. Following the end of the war, the Permanente Health Plan was opened to the public, gaining 300,000 members in the first 10 years (KP, 2009).

The Kaiser Permanente system focuses on community-based healthcare and education; it teaches classes, has weight loss groups, and works to prevent disease and maintain health through lifestyle (KP2, 2009). It maintains health rather than solely treating diseases. The members pay a flat rate regardless of the services provided; therefore physicians and hospitals have a financial incentive to keep people healthy rather than making money from illnesses (Rodriguez, 2009). Organizationally, this HMO has designed a coordinated delivery system with as many services as possible, therefore allowing for an ease of access and coordination of care than may be missed in other delivery systems (KP3, 2009). Since the system developed during times of significant economic hardship, it is important to note that the financial incentives are also in place to help reduce costs by maintaining health.

Given the current economic hardships that have persisted throughout the country in recent years, as well as the pending social and political overhaul of the medical and healthcare systems, one would be wise to consider the possibility of a Hygeian model of delivery similar to that of Kaiser Permanente. The system would be focused on addressing lifestyle and social aspects of the American culture that negatively impact health, such as smoking, obesity, malnourishment, and the routine overdosing of certain over-the-counter drugs such as acetaminophen. This system would micro and macro-allocate resources so that there was a greater emphasis on health education and disease prevention. Financial incentives would be offered for maintaining health, and compensation could be based on avoiding certain conditions (Rodriguez, 2009). This system would be more likely to focus on vaccinations and preventative screenings, while maintaining excellent care for the treatment of diseases.

The Hygeian modeled system would likely cause shifts in the entire healthcare system, including the ethical and legal elements. Ethically, the same Code of Healthcare Ethics would apply as in the current system; however a greater emphasis would be placed on preventing disease, specifically within the principle of beneficence. Not only would the standards of the profession require to care, comfort and cure, but also to prevent disease (Rodriguez, 2009). Also, the non-malfeasance principle would include not only doing no harm, but doing what is possible to prevent harm. In this manner, the focus is shifted not only from treating and curing patients, but also helping to protect them against preventable diseases.

Likewise, the legal system would shift to reflect the delivery model’s key element of prevention. Malpractice would include not only the components that it currently does, but providers could be sued for failing to properly prevent disease.

Providers and healthcare workers would have a moral obligation to prevent illness and disease; they would be morally obligated to attempt to educate and guide, to coach by word and example, methods for living healthier lives.

The greatest dilemma facing the institution of a nationwide HMO would be the current Aesculpapian model which reimburses providers based on testing and treatment rather than prevention. The shift from treating diseases to preventing diseases would be significant and likely a difficult move for many healthcare organizations as currently operated. A second problem that would interfere with the HMO would be addressing the underserved (Rodriguez, 2009), similar to the problem that faces the current model and reform debates. Financial ability to access such HMO programs would have to be carefully adjusted so that the impoverished received the necessary care to meet their needs. Additional issues facing the success of the Hygeian model would be the negatively impacting lifestyle components such as smoking and fast food. Legislation would need to be enacted to limit the profits of such industries, using taxation to negate some of the significant financial weight that is added to the healthcare expenditures. An estimated $1.47 billion dollars are spent each year treating obesity (Pollan, 2009); without noteworthy efforts to reduce the fast food industry’s impact on the nation’s health, the HMO would likely be unable to appropriately address health maintenance and disease prevention.

Given the tremendous financial burden caused by obesity, one would likely consider implementing a fast food tax similar to that of the taxes placed on other social negatives such as cigarettes as a form of deterrent. Following the tax, federal and state efforts would need to be made to obtain and secure affordable sources of healthy foods such as fruits and vegetables.

Considering the aforementioned data, one would likely want to take proactive steps to prevent disease within the healthcare organization. Such practices could include increasing patient education through community based classes, as well as school outreach, public information campaigns utilizing posters and hand-outs relative to the population demographics including language ability. This is especially important when addressing immigrant or less-educated populations that may need to have information provided in an easily accessible manner.

One would also consider encouraging the healthcare organization to encourage health within its own operations, perhaps carrying a health insurance plan that offers financial incentives for having good health habits such as working out at a gym. Another lesson to be garnered from the Hygeian system is the importance of the person as a whole, not as a single disease entity. Current healthcare delivery models should reflect the value of the whole instead of focusing on the disease. Given the current sociopolitical environment, one would likely want to evaluate the performance and outcomes of the HMO style delivery system and legitimately consider its applicable values into the current reform. By addressing matters of disease prevention, the long-term costs should be reduced and appropriately managed.

References

Atsma, A. (2008). Hygeia: Greek goddess of good health. Retrieved 12 December 2009 from http://www.theoi.com/Ouranios/AsklepiasHygeia.html.

Fremgen, B. (2009). Medical law and ethics (3^rd ed.). Upper Saddle River, NJ: Prentice Hall Health.

Kaiser Permanente (KP3). (2009). Fast facts and Kaiser Permanente. Retrieved 13 December 2009 from http://xnet.kp.org/newscenter/aboutkp/fastfacts.html.

Kaiser Permanente (KP). (2009). History of Kaiser Permanente. Retrieved 12 December 2009 from http://xnet.kp.org/newscenter/aboutkp/historyofkp.html.

Kaiser Permanente (KP2). (2009). In the community. Retrieved 13 December 2009 from http://xnet.kp.org/newscenter/inthecommunity/index.html.

Pollan, M. (2009). Big food vs. big insurance. Retrieve 11 September 2009 from http://www.nytimes.com/2009/09/10/opinion/10pollan.html.

Rodriguez, R., Ph.D. (2009, December 7). Chat posting. Retrieved from AIU Online Virtual Campus. Chat 1 week 5. The ethical and legal aspects of healthcare: HCM410-0904B-02 website.