Opposing Drivers In Health Reform – The Healthcare Professionals’ View

An upcoming global study, to be launched at the Health 2.0 conference later this year, asks the question:

How do healthcare professional (HCP) opinions on health reform differ between the United Kingdom and the United States; each a nation facing complex reorganization of their public health care service?

We previously reviewed the inextricable link between health and politics, regardless of whether reform is actually a component of policy or not. This week, we explore the viewpoints of HCPs on some major drivers in health reform.

Opposing Drivers In Health Reform

I like to imagine that the concept of health reform is in its most distilled essence a value equation, where the equation variables and parameters are health ‘drivers’ each affected by another for the benefit of all involved.

Let me be the first to admit this is not a novel approach.


Indeed Professors Michael Porter and Bob Kaplan from Harvard Business School have looked at modelling the cost crisis in health care. In a further evolution of such thinking, Dr. Vivian S. Lee and her University of Utah Health Sciences collaborative community have dev­eloped The Algorithms for Innovation.

Even so, arriving at an idealized scenario that truly represents a ‘balanced’ health reform value equation is at best difficult, if not impossible, to achieve in reality.

Different stakeholders tend to value each component of the equation from their ­own perspective. As such, trying to provide a national health reform that ticks all the proverbial boxes harkens those words made famous by Abraham Lincoln[1],

“You can fool [please] all the people some of the time, and some of the people all the time, but you cannot fool [please] all the people all the time.”

So seeking to understand just ‘…some of the people’ in the health ecosystem, what do healthcare professionals think are the important drivers for the value equation?

We have seen that since the last Health 2.0 conference, a majority of public social media content from among 8,000 HCP posts in both the United States and the United Kingdom, reveals ‘cost’ to be the key topic in conversations specific to health reform (See Figure 1).


Figure 1 – An analysis of health reform ‘drivers’ reveals that cost is a key topic.
(Source: Creation Pinpoint, NUK=811 NUS=7558)

Cost is not necessarily mentioned in isolation; in many cases any reference is in the context of another health reform driver – such as the next most mentioned topics of quality, preventative medicine, safety, waiting times, or finally staffing issues.

Cost – In the context of ‘quality’

Receiving the best possible quality of care is a fundamental human expectation, should we find ourselves with a health problem. On the whole, we generally trust that requirements exist for excellence in training, sufficient resourcing, provision of best-in-class treatments and that there is a general commitment from our respective healthcare systems to high standards in every aspect of delivery.

Yet, for the equation to balance, there is usually a lowest common denominator that may bring compromise to one or more of our expectations.

HCPs are all too aware of the forces at play and the compromises that must be made, in both individual and macroeconomic theatres of health care. In some cases we see HCPs provide a balanced perspective in stark contrast to the rhetoric of those who rally with one political camp or another.

For example, during a Twitter conversation with an Australian nurse (Figure 2), physician and cancer survivor Dr. Preston explained that while the Obamacare health reform certainly increases access to health insurance, it does not therefore increase the quality of care – or decrease costs for that matter.

ff3Figure 2 – Dr. Preston explains how Obamacare does not necessarily increase the ‘quality’ of care (Source: https://twitter.com/GavinPrestonMD/statuses/457568468133371904)

Likewise in consideration of new health reforms and policies for the United Kingdom; as politician Jeremy Hunt extols the ‘fairness’ of the NHS, physician and Lecturer Anne-Marie Cunningham reminds her followers and the delegates of the General Medical Council conference that fairness applied towards access to quality services is also important (Figure 3).

ff4Figure 3 – Anne-Marie Cunningham suggests equity, access, and quality as important drivers. (Source: https://twitter.com/amcunningham/statuses/411140393011396608)

Cost – in the context of resources

Web-lebrity physician Kevin Pho shared his viewpoint on an issue of expanding insurance without expanding the primary care infrastructure, pointing out that this is likely to lead to more patients presenting at hospital emergency departments.

In response to this, paramedic Steven Grayson blogs:

“When it comes to healthcare, your choices are quality care, easy access, and low cost. Pick any two, because having all three ain’t possible. Anyone who says otherwise is either a liar or a politician.”

United Kingdom nurse ‘Gerry’ (Figure 4) points to an article about government cuts to nurse training programs which seem to have resulted in greater costs through overseas recruitment to fill gaps in resourcing. This story receives a resounding level of support from other HCPs who retweet the story to their own professional and social networks.


Figure 4 – Nurse ‘Gerry’ points to a story which is widely retweeted by other HCPs
(Source: https://twitter.com/archangelolill/statuses/466691148094791680)

Balancing The Health Reform Value Equation

Trying to find the right balance in the various drivers for health reform is clearly difficult. By and large, healthcare professionals see cost as the biggest issue within the debate; however there concerns about cost are always connected to human health issues, such as the quality of care, resources or access to services. It is clear that they are seeking better health for all, but understand that cost is a limiting factor in the equation.

In the next article from this series, we will look at health insurance as a component of health reform. What will healthcare professionals insights tell us about insurance concerns?

If you have a keen interest in HCP views on health reform, you will have access to the full study by attending the Health 2.0 conference. For now, why not subscribe to the Health 2.0 blog and receive weekly updates as we unpick the differences between health reform in the UK and the USA.

If you are not already attending the conference, it is not too late to register.

About the author: Paul Grant (@paulgrant) is Chief Innovation Officer with Creation Healthcare. At the Health 2.0 fall conference, he will present research conducted using Creation Pinpoint, a service for analyzing healthcare professional opinion expressed through public social media.



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