Health care leaders recommend restructuring US health care system

Leaders in health care recommended restructuring the U.S. health care system in ways that support more efficient, targeted health care delivery. The recommendations were recently published in JAMA.

 Evolving health care systems

 “Today, our nation’s health is evolving, the U.S. population is aging and our health care system is gradually adopting more patient-centric and value-based models of care to better serve the needs of the U.S. throughout the 21st century,” researchers wrote. “To keep up with the evolving needs of our nation’s health and health care system, a series of papers recommends restructuring the health care system.”

 One of the papers, “Workforce for 21st century Health and Health Care,” was authored by Steven H. Lipstein, MHA, president and chief executive officer of BJC HealthCare, and Arthur L. Kellermann, MD, MPH, dean of the F. Edward Hébert School of Medicine at the Uniformed Services University of the Health Sciences. It summarizes recommendations of a National Academy of Medicine writing team, made up of distinguished health care leaders.

According to the data, the authors envision an interdisciplinary health care workforce organized for four major groups of patients. The first are people who are generally healthy, including those who experience only intermittent or minor episodes of illness or injury, and those who need maternity and perinatal services for uncomplicated delivery of healthy newborns. The second group is patients who experience acute and major episodes of illness and injury, such as a car crash or heart attack. The third are patients who have significant chronic medical and behavioral conditions, especially those with multiple, complex and co-occurring conditions, and the fourth group is people approaching the end of a natural lifespan.

Improving care

“To improve the care Americans receive in the 21st century, we need to recruit, educate and sustain a diverse workforce of compassionate health professionals that are comfortable working in interdisciplinary teams, technically skilled, adept at using telehealth and health information technology, and consistently responsive to patients’ needs,” according to Kellermann.

To promote health and prevent minor problems from developing into major ones, researchers suggest physicians, registered nurses, physician assistants, social workers, nutritionists, exercise physiologists, public health and other health professionals implement the use of telehealth and other technologies to extend their reach outside of fixed health care facilities.

They also advocated regionalizing care of patients with acute and major episodes of illness and injury in high-volume, high-expertise centers as a way to improve outcomes, reduce costs and improve education of future healthcare professionals. They add that the workforce that cares for these patients should be interdisciplinary, and include paraprofessionals, such as community health workers, primary care technicians, and others who can work with chronic diseases. They suggested employing home monitoring technologies for patients with significant chronic medical and behavioral conditions, and increasing providers skilled in palliative and hospice care for individuals approaching the end of a natural lifespan.

The researchers noted these approaches could reduce overall health care costs and improve education, as well as keep more patients out of the hospital and improve quality of life. – by Shawn M. Carter


Lipstein S., et al. JAMA. 2016;doi:10.1001/jama.2016.13715.

Disclosure: The researchers report no relevant financial disclosures.

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