1. Bartol, Tom APRN

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Our healthcare system is not functioning effectively. In the United States, we spend more per capita on healthcare, the highest in the world, yet the nation ranks only 37th in the world for health status, and life expectancy is only 42nd.1-4 We are not getting a good return for our healthcare dollars. The average family of four pays $24,671 per year in healthcare premiums (payments plus employer contributions), and the average individual will spend an estimated $1.8 million on healthcare in a lifetime.5,6 With higher costs and poorer health, many of the changes intended to improve or reform healthcare are resulting in increased costs, increased work, and little (if any) improvement in health. Changes such as electronic health records had a goal of improving care, but they are cumbersome-something we have to work with rather than it working for us.

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Creating something new

NPs check more boxes, use more technology, and produce more data without a significant change in the cost or quality of healthcare. Payment reform is the latest trend, but this will likely add more boxes to check, more bureaucracy, and more steps to our current dysfunctional system. Healthcare does not need reform or transformation but a recreation from the bottom up, innovating a system that is grounded in health and caring.


Attempts at reforming and transforming healthcare have been like repairing or fixing up a 50-year-old car, adding newer equipment and modern technology to try to make it better. The problem is that we do not consider if the original vehicle is really what is needed today. Perhaps a more appropriate vehicle would be something without wheels or a combustion engine, or one that drives itself. The way we are doing healthcare (giving it, paying for it, and evaluating it) may be like that 50-year-old car. As Socrates said, "The secret of change is to focus all of your energy, not on fighting the old, but on building the new." It is time to forget the old and recreate something completely new.


What we refer to as healthcare today is actually "illness treatment" or "symptom treatment." It is an institution-based process that patients enter because of a perceived illness or disease, and their symptoms or "numbers" are treated, usually with procedures and medications. The payment system pays for doing more work and seeing more patients with little incentive for patients to be or stay healthy. There is little room in the current system (or payment apparatus) to work with individuals who are healthy and to keep them that way. Efforts are focused on the high spenders in healthcare while we do little to keep those not using the system healthy.


Most healthy individuals do not come to a clinic or hospital. The current process of physical exams or "preventive care" has become scripted, resulting in more checked boxes with little effect on improving health outcomes.7 Healthcare has become "health profit," with the industry looking for ways to make money based on what is reimbursed and not on what will make the biggest difference in a patient's health.


Recreating healthcare takes a new approach, a new perspective, forgetting the ways we have always been doing things. It revisits how we do healthcare, who does it, where we do it, and how it is reimbursed. It will not come from a government intervention, through guidelines from an expert panel, or from payers. No one person has all the answers. Recreating healthcare will happen when each of us thinks in new boxes, trying different ways of doing things and sharing these ideas with others. Albert Einstein said, "If at first, the idea is not absurd, then there is no hope for it." We must think in new ways that may seem absurd to our current model of healthcare.


A lesson from technology

Recreating healthcare can be like open-source software (publicly accessible and anyone can modify and share it). Networking together via the Internet, all of us can share our ideas by brainstorming, listening, sharing, trying new ideas with an open mind, and keeping an eye on health and caring. However impractical or unreasonable the ideas may sound, we must not limit ourselves by the current culture of healthcare.


For example, recreating healthcare would engage all people, whether they perceive themselves as sick or well. Rather than having "check-ups," everyone would have regular "check-ins," building a relationship with a healthcare provider who cares and gets to know the person and his or her goals, values, challenges, and struggles. A check-in would not be just for the "sick" or those with problems but would serve as an opportunity for every individual to develop a supportive relationship with their healthcare provider. Rather than asking, "What is the matter?" the check-in would ask, "What matters to you?" It would help each person find connection, purpose, and hope in life, key foundations for health and caring.


We all experience challenges and stress from relationships, financial problems, work, or past traumas. Although we may not perceive ourselves as ill, stress can weaken our immune system, cause us to overeat, and lead to hypertension, heart disease, or other illness. The healthcare recreation would treat the causes, our response to stress, our feelings of self-worth, lifestyle, and relationships rather than simply treating the symptoms once illness or disease manifest.


The check-ins could begin in the first year of school, with a school nurse meeting with every student once or twice a year to develop a relationship. Everyone would see the school nurse to check in and talk.8 The nurse would provide counseling as needed and find resources in the school and the community for those identified with problems, challenges, or risks. Seeing the school nurse would become a normal part of everyone's curriculum. The check-ins could continue in college and the workplace. These would not be traditional health screenings but a way to build relationships, share information, provide support, and offer resources.


Nudging us to health

Another idea could be to transform our lifestyle through small nudges here and there. Imagine if healthy food was provided at the workplace as well as a time and place to exercise. What if the federal government subsidized broccoli instead of corn and high-fructose corn syrup? Some would say this might cost too much, but it would cost far less than what we currently spend on healthcare and would help people learn and develop healthy habits before a disease manifests.


The clinic and hospital might become one very small piece of the healthcare process while the majority of recreated healthcare takes place in the locations people already go to each day, such as schools, the workplace, churches, and grocery stores. Healthcare would not be isolated in a separate building but part of our daily lives. Critics may find reasons why such a model would not work or would not be reimbursed, but the fact is our current system of healthcare is not sustainable. If we do not change the current structure and culture of healthcare, it will implode. We can be critical, or we can choose to be part of the change.


Sharing information is essential for this change. We need to network and share our ideas, provide feedback, refine concepts, and create a new system. The website http://www.recreating has been developed for this purpose.


Creating a new culture

We all have the ability and responsibility to recreate healthcare. We cannot rely on politicians, insurance companies, and expert panels to make these changes. Each of us, thinking in new ways, unlearning what we have always been doing, and sharing ideas can create a new culture of healthcare-one that emphasizes health and caring and goes beyond treating illness to maintaining and enhancing health.


Recreating healthcare actively engages every individual to develop a healthy body, mind, and spirit. The current system will continue to push us toward illness treatment, but we can innovate and explore ways to make a difference. Each of us, thinking in new ways and sharing our ideas, can give new life to health and caring.




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3. Central Intelligence Agency. The World Factbook. Country comparison: life expectancy at birth. 2015.


4. Centers for Disease Control and Prevention. FastStats: life expectancy. 2016. [Context Link]


5. Munro D. Annual healthcare cost for family of four now at $24,671. Forbes. 2015. [Context Link]


6. Goldhill D. Catastrophic Care: How American Healthcare Killed My Father-and How We Can Fix It. New York, NY: Vintage; 2013. [Context Link]


7. Mehrotra A, Prochazka A. Improving value in health care-against the annual physical. N Engl J Med. 2015;373(16):1485-1487. [Context Link]


8. Bartol TG. Recreating healthcare begins with the school nurse. Medscape. 2016. [Context Link]