In revising the American health care system, it is critical to look at current delivery systems and determine what has worked and what has failed.
In looking at our track record, we have several models to review. These include the programs of Medicare and Medicaid as well as the Veteran’s Administration health care system.
The Medicare system might be the first to consider. According to CMS, there are roughly 55 million members in the system. Although this is a large sampling, the inherent nature of a program for seniors is going to have a disproportionate number of medical problems, hospitalization and poorer outcomes.
The Veteran’s Administration has almost 9 million enrollees and serves a wider age range. However, it’s a uniquely integrated system of 150 hospitals, 820 community-based outpatient centers and 300 special service centers that take this program away from the mainstream of health care delivery.
The June 2017 report from CMS shows just a little more than 68.5 million enrollees in the Medicaid program, making it the largest. The program serves a broad age range and overlaps Medicare with about 10 million members that are dual eligible. The program is also unique in that it is a federal-state partnership that has allowed for the programs to evolve differently in each state.
Medicaid is also a unique program in that it serves a diverse population and has more opportunity to look at the social determinants of health. Population health research has found that access to health care services is not the strongest correlation for best health outcomes. Health behaviors such as smoking, diet and exercise are the most important factors in longevity. Social, economic and environmental factors can also be a barrier to healthy lifestyles (Heiman et al.).
Medicaid has more experience in developing social services that integrate with medical services, and several state programs have the data to demonstrate the importance of this link for diverse populations (Witgert).