On October 31, PHC had its second lunch series discussion of the semester with Professor Howard Forman. His talk examined the facts, current status, and future challenges of U.S. healthcare reform. Professor Howard Forman, MD, MBA wears many hats as a health services researcher focusing on diagnostic radiology, health policy, and healthcare leadership. He not only serves as a practicing emergency/trauma radiologist and operational chief for Diagnostic Radiology at Yale-New Haven Hospital, but also directs the Healthcare Management Program in the Yale School of Public Health, and is faculty founder and director of the MD/MBA program between Yale School of Medicine and Yale School of Management. In the midst of his busy schedule as a physician and economist, Professor Howard Forman also teaches ECON 170: Health Economics & Public Policy, a Yale College course well sought-out by many students with varying interests in healthcare.
Professor Forman started off his lecture by defining the three healthcare challenges that we currently face in the U.S. First, the U.S. has the highest per-capita spending on healthcare, creating a public finance and private market impediment to global competiveness. Second, a large population of uninsured and underinsured persons in this country leads to problems with access to medical care. Last, even when people do have access to medical care, the quality of care across providers is completely uneven. This last problem is primarily driven by a misalignment of incentives between healthcare providers and consumers.
Professor Forman next discussed the aims of the reform movement to address healthcare cost growth, to make insurance available and affordable to everyone, to provide publicly-financed healthcare to the poorest Americans and subsidies for private market coverage to lower-middle class individuals, and change the incentives to improve the quality of healthcare delivery. He explained that the ACA mandates that every American citizen be covered by health insurance as a way to reduce healthcare costs and increase the number of people insured in this country. By forcing people into the health insurance risk pool through a small penalty, it ensures a steady stream of income and helps to bring healthy, young people into the pool. In terms of quality of care, Howard Forman explained that the ACA is experimenting with pilot schemes that have an outcome-oriented payment model. As of now there are no incentives in healthcare delivery to improve outcomes. Currently, the fee-for-service model encourages increased volume of care, as opposed to quality of care. In order to change behavior to encourage population-based care, the ACA is now penalizing healthcare providers for hospital readmissions. With all that healthcare reform has aimed to achieve, Professor Forman certainly did not fail to stress the imperfections of the ACA, which can largely be attributed to the continuing political struggle surrounding the bill.