The Health Care You Told Us You Want

It’s a tough time to ask questions about health care right now, but we did it in our February survey of Next Avenue readers about person-centered care. Why tough? With a debate roaring in the news about health insurance, care itself is harder to focus on.

So as we report back to you about the survey results and your collective wishes about health care, here are a few things to keep in mind:

• Person-centered care is an approach to care that pre-dates the political fray over the Affordable Care Act and its possible replacement. In short, person-centered care is care that’s based on the person’s own realistic health and quality of life goals.
• The American Geriatrics Society (AGS) published an updated definition of person-centered care in January 2016, which was the basis of our survey questions about health care.
• No political party is advocating person-centered care as defined by the AGS. (Confusion might stem from the fact that the Republican leadership in Congress adopted similar language — “patient-centered care” — to describe their vision for reforms to health care and health insurance.)
• Person-centered care is relevant in the current discussions about health care costs because person-centered care has shown the potential to reduce costs to the health care system. For instance, by filling low-cost non-medical needs that help older people stay in their homes when they want to, health care providers reduce the likelihood that those elderly will need costlier help, such as hospital or nursing home care.

With that background in mind, here’s what 962 Next Avenue readers told us about their experience of health care and how they’d like it to change.

Most people who took part in the survey said they are satisfied with their current health care. When it comes to both health outcomes and the experience of care, 35 percent said they are satisfied and 25 percent said they are very satisfied with their care. Only about 20 percent said they are dissatisfied, and another 20 percent described themselves as neutral.

Still, most people in our survey (86 percent) said they would prefer to have person-centered care — that is, care based on their individual goals, values and preferences. What would that kind of care look like? In person-centered care, health care providers ask patients about their goals and priorities and build each person’s care plans around the answers. If one of your priorities was to minimize the number of prescription medications you take, for example, you might get help to try an effective alternative like yoga or other exercise for back pain instead.

There are countless examples of what person-centered care can be, precisely because it is based on individual values and goals. But in every case, person-centered care relies on patients having a chance to express their goals and preferences. That element of communication is where most survey participants said their current health care falls short.

• Most people said they are never (52 percent) or only once in awhile (31 percent) asked about their health and quality of life goals and preferences.
• Most said their health care providers don’t understand their goals and preferences at all (24 percent) or don’t understand them very well (41 percent).
• And most (70 percent) said they’d like a chance to talk more with their health care providers about their health and quality of life goals.

At the same time, survey participants recognized why more communication is hard to come by. In the open-ended comments they gave, one recurring observation was about the time constraints that physicians operate under, with just a few minutes to spend on each patient. Another repeated observation was that reimbursement from insurers skews the way our time with physicians is spent. Doctors are reimbursed primarily for tests and treatments, not for the time they spend understanding their patients’ priorities or helping them move toward their goals in a holistic and preventive way.

Which brings us back to the health care debate that dominates the news right now. Would we all be better off if the discussion was about how our health care system uses time and not just how it uses dollars?