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Healthcare responsibilities shift to providers and patients

June 18th, 2014

by Carmela Coyle

We all know many things affect our patients' health--genetics, lifestyle choices, access to medical care. To understand that more completely, consider a few statistics from a recent report by the Robert Wood Johnson Foundation and the Trust for America's Health:

  • Only 10 percent is determined by hospitals and doctors who care for us when we get sick.
  • Twenty percent of our health is derived from genetic makeup--our predisposal toward certain diseases, as determined by our parents' genes.
  • Twenty percent is influenced by our environment, such as a lack of clean water and clean air.
  • Half of our health is influenced by our behavior--whether we smoke, drink, exercise and other choices that only we make.


Those are telling numbers by themselves, but there's one more statistic to think about before figuring out what this all means: Medicare, the federal program that covers Americans over 65 years old, spends 85 percent of its dollars taking care of only 25 percent of its enrollees.

Something isn't quite adding up. The majority of healthcare spending is for a fraction of the people.

For years, healthcare leaders and policymakers have worked to reverse this trend--to find ways to encourage better lifestyle choices. Take for example, smoking, where policy decisions in Maryland led to higher costs per pack and lighting up is prohibited in public restaurants. Maryland's adult smoking rate is now 19.1 percent, 11th lowest in the nation.

What does this have to do with hospitals? With the recent national push toward reducing avoidable volume, hospitals work harder than ever to keep people out of emergency rooms and hospital beds.

In some cases, that will mean efforts that take doctors and nurses beyond the four walls of the hospital and into the community, to encourage people to take greater ownership of the 50 percent of factors they can control in their health--the things they put into their bodies and how they treat their bodies.

There are financial incentives for this, to be sure, but there's a greater benefit as well--healthier communities that need less acute medical care.

This is a big shift from the traditional hospital model, where more volume meant better bottom lines. But if you look closely at the missions and values of just about every hospital in the country, you will see messages of healing and health, not comfortable operating margins.

Pair this change with the implementation of the Affordable Care Act, and the American healthcare system is undergoing perhaps its most dramatic change since the introduction of Medicare in the 1950s.

There are a lot of moving parts to this transformation, but there's no question that individuals will be asked to take greater responsibility for the care of their bodies, and that hospitals and healthcare systems will do everything they can to help them.

Carmela Coyle is president and CEO of the Maryland Hospital Association, focusing on advocacy and public policy.


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