The emphasis on quantity over quality seen in our health care system has deep roots in our culture. See how a citizens group in Minnesota is trying to change it. By William Doherty, Ph.D., and Bill Adams
Primary care providers are keenly aware of the dangers and consequences of the “more is better” culture of our health care system. But too often when they push for quality over quantity of care, they are criticized for championing primary care over other specialties. Government doesn’t fare much better getting the message out. Any campaign to cut unnecessary costs is met with public outcry about “health-care rationing” and “death panels.” When the health care companies and insurers try to curtail overuse, they are accused of profit mongering. When hospitals and medical specialty associations criticize excessive care, it’s often about what other hospitals and specialists are doing. That’s why a group of citizens took it upon themselves to launch Baby Boomers for Balanced Health Care.
The organization was formed out of a conviction that unless everyday community members get involved in the conversation about medical overuse and cost savings, nothing meaningful will change. We are a small group of citizen Baby Boomers (including one primary care physician) who believe that health care spending is out of control and will bankrupt our country unless we all take responsibility for changing how we do health care. Our goal is to create a public conversation about a neglected dimension of the problem: the cultural belief that more health care is better health care, a belief that contributes to overdosing on health care: too many tests, procedures, and devices that can cause harm along with bankrupting individuals and communities. We are calling for a new mindset that values balanced health care—“Goldilocks” health care—not too much, not too little, but just right.
The project was initiated by Bill Doherty and Jim Hart, a primary care physician, using the Citizen Health Care
model Doherty developed. We approached citizen organizations in Minnesota to recruit engaged Baby Boomers to come together to reflect deeply on the more-is-better cultural dimension of the health care crisis in the U.S. Without new cultural norms, we argued, health care reforms, such as payment for outcomes instead of services, will yield backlash. Citizens groups can lead the way where government and health care professionals cannot.
So why Baby Boomers? When we asked members of our group about their generation’s unique role in this issue, they said, “We came of age in abundance, witnessed medical miracles like the polio vaccine and heart transplants, and came to believe that more is always better in many areas of life, including health care. We were wrong. Now that we are elders, we want to lead a cultural conversation about restoring balance in health care: smarter health care, not more health care.”
So far we’ve developed community conversation guides (for small groups and larger community forums) and sponsored conversations around the Twin Cities and in Fergus Falls, Minnesota. Three-month follow-up evaluations indicate that the average participant has talked with seven other people about medical overuse and the more-is-better culture.
We’ve also partnered with Consumers Reports and Choosing Wisely to make these conversation guides (including video demonstrations) available nationally. Doherty and Adams have given webinars on Choosing Wisely and citizen engagement, as well as presentations at Lown Institute and Institute for Clinical Systems Improvement conferences.
We’ve developed and begun working with Minnesota-based HealthPartners to implement a “Clinician Guide for Conversations about Medical Overuse.” This guide, spearheaded by Baby Boomer member and family physician Cate McKegney, will become part of continuing medical education and specialty re-certification training. In a year, we hope the training materials will be available nationally. HealthPartners will also begin sponsoring community forums using our conversation guide.
Finally, we are looking into ways to distribute our “Guide for Families and Loved Ones” for talking about overuse.
It’s still an open question whether Baby Boomers for Balanced Health Care will play any role in reducing out-of-control health-care spending in the U.S. But this project illustrates a community and cultural change method of working together with other citizens to tackle a problem that cannot ultimately be solved unless we-the-people, not just we-the-professionals, get involved. We hope it will inspire your conversations with patients, friends and loved ones. And we hope our citizens’ movement will inspire your continued grassroots work to transform the health care system.
William Doherty, Ph.D., is Director of the Citizen Professional Center and Adjunct Professor in the Department of Family Medicine and Community Health at the University of Minnesota. He has developed Citizen Health Care as a way to engage community members as co-producers of health care innovations.
Bill Adams is engaged in health care public policy issues. As an engaged citizen and patient voice, he focuses on local and national initiatives to transform health care by co-creating a health care system that works for both patients and providers.