Saturday, January 30, 2010

A Job for the ACO

In an Op-Ed article in the January 25 issue of The Boston Globe, pediatrician Claudia Gold recited the sad tale of Emily, a patient who was returning for care that she (Dr. Gold) was not able to provide. Emily was returning because her psychiatrist was no longer accepting her insurance.

Dr. Gold used this situation as an example of the need to change the direction of health care. She suggested that the wrong direction in which it is now going could be attributed to “the combination of a health insurance industry wielding huge power and a seriously undervalued system of primary care and mental health care.”

We have family in London, England whom we visit with some frequency. I make it a point to read a local newspaper while there (usually the Daily Telegraph) and often find similar tales of woe relating to the British Health Services.

Friends of ours in the US Foreign Service were recently stationed in Ottawa, Canada and from time to time would send me newspaper articles chronicling the failures of the Canadian health system.

All of this leads me to conclude that there is no system of health care that will meet everyone’s need every time.

That leads me to a second conclusion, which is that every system, however financed, needs a local focus of responsibility. When the system fails and someone “falls through the cracks,” there ought to be someone responsible for making sure that needs are met.

There has been recent talk about creating something called an Accountable Care Organization, or ACO. Maybe looking after people who have been failed by the system is one of the things for which it could be accountable.

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