Health care: Are you really satisfied?

If you truly are satisfied with your health care, I would venture to say you won’t be for long. You may be satisfied with your health insurance, but with the rising cost of care, you likely have not been pleased with increased cost-sharing, rise in premiums, deductibles and/or co pays. (Premiums in New Hampshire have risen 95 percent since 2000.)

You may be satisfied with your primary care provider, but with a threatening primary care physician shortage, over time having easy access to a primary care provider may only be a luxury (residency spots in family medicine have declined over 50 percent in the last 10 year). You may be satisfied that your employer helps cover a portion of your insurance costs, but with a national and state trend to reduce or eliminate this benefit and with a weakened economy, your employer-based health insurance coverage may not be there for you in the future. (In New Hampshire, 75 percent of employers are small businesses, with employer coverage declining recently to only 51 percent.)

You may be satisfied with your public insurance plan (Medicare, Medicaid, VA) or your private insurance plan, but with relentless medical inflation, the status quo of your plan’s benefit package may be financially unsustainable. (In New Hampshire, family premiums cost nearly $15,000, about the annual earnings at a full-time, minimum-wage job.)

A national survey of businesses just released by the Kaiser Family Foundation and the Health Research & Educational Trust found that, since 1999, health insurance premiums for families rose 131 percent, far more than the general rate of inflation, which increased 28 percent over the same period.

The annual survey of more than 2,000 companies found that 40 percent of small-business employees enrolled in individual health plans pay annual deductibles of $1,000 or more. That’s almost twice the number who paid that much in 2007.

And as insurance costs increase, workers are also picking up a larger share. The average employee with family coverage paid 26 percent of the premium, the study found, but 41 percent of companies said they are “very likely” or “somewhat likely” to increase the amount employees pay for coverage in the next year, according to an article in the Sept. 17 issue In short, certain change is required.

The question becomes, which change? From my point of view, from within the system, health-care reform is about health systems reform, not just health insurance reform. It is about reimbursement for care that delivers healthy outcomes, not just for performing tests or procedures.

It is about building a health-care system and a physician workforce that will be there for you, your children and your grandchildren. 

It is about moving away from our wasteful patchwork system and building a comprehensive coordinated system that financially and clinically integrates all your care, including your primary and specialty medical care, oral health, behavioral health and hospital care.

It is about coverage and access to care that is available and affordable for everyone.

No one in this country or in this state believes change will be easy. And to be sure, any true reform is complicated. There is no one solution. However, we deserve a balanced, honest and civil exchange about the reform. And while our congressional delegation may have different perspectives on how to make the necessary changes, they all agree on one thing: community health centers work — and must be supported and encouraged to grow.

Community health centers are nonprofit practices across the nation serving nearly 20 million patients. In New Hampshire, they serve as a health home for over 107,000 patients, offering quality, comprehensive, and integrated care to everyone in their community — regardless of ability to pay.

The research is striking and the data are clear that the centers provide patients with healthy outcomes while saving the overall health-care system on average over 30 percent. Their cost savings are due to patient and family involvement in their own care — everyone focusing on coordinating primary/preventive medical, oral and behavioral health care managing chronic illness and reducing emergency and hospital care.

Our current system is fragmented and on an unsustainable trajectory. Let’s work together to examine and repair what is broken while we continue to invest in what works.

Teresa Stack Kuenning is executive director of the Bi-State Primary Care Association.