How the crises of healthcare and education are related


There are two crises in America, both of which have a profound effect on the economy.  The cost of healthcare is eating away at our ability to finance other needy areas.  Poor performance of our educational system is weakening our international competitiveness. Both healthcare and education are at the precipice of complete collapse.  They both deliver glaringly inferior results with prohibitive expenditures.  The performance of our healthcare system relative to other developed countries was abysmal when examined from multiple perspectives, while spending nearly twice that of the country with second highest per capita cost.  This was well-documented in a recently published Commonwealth Fund study, which was the subject of a past feature by this writer.

The education system in this country is analogous.  We spend again magnitudes more than the countries with the highest performing students, yet the United States is ranked 14th out of 34 other OECD (Office for Economic Co-operation and Development) studied countries for reading skills, 17th for science and a below average 25th for mathematics in a recent report.  Only eight countries have a lower high school graduation rate than the US.  So why are the similarities of these two important facets of our society so important?  I believe that it is because the solution to both must be to rethink processes and their evaluation in very fundamental terms.  There are stakeholders in both areas that have competing interests in such change.  Physician and hospitals are skeptical that radical change would decrease reimbursements.  This is seen in the debate over accountable care organizations.  Medical device and pharmaceutical companies are afraid of radical changes in purchasing models. The insurance industry is already running for the hills in many respects, threatening that there won’t be resources to cover people if reform comes. In education, teachers unions are afraid of losing their grip on members who have been shielded with tenure in the ‘Last in, First Out’ mode of layoffs where newer, sometimes better and more needed teachers are let go in budget crunches first, over less competent (sometimes already severely disciplined) established teachers. Students and their families might be upset if reform brings a longer school day and perhaps school year. The powerful standardized testing industry might no longer be the holy grail of measurement of success.

Both medicine and educational systems are mired in historical tradition.  The training of physicians, teachers, and students has not substantially changed for the good part of a century.  Admittedly simplistically, benchmarks of success of medicine are the financial profits of hospitals (albeit small that they are today), and the eradication of a symptom or treatment of a disease.  Those of education are graduation rates and standardized test results.  I believe that both fall significantly short of their potentials.  Medicine needs to address preventive care and fitness, as well as treating diseases more efficiently and cheaper.  Education needs to aim for creating an atmosphere where students that do well because of their desire to learn and enthusiastic well-qualified teachers motivate them.  Engagement is something that both patients and students need for healthcare and education to succeed.  It will be the key to success of mHealth as well as a new paradigm for education. Healthcare is not brought to a patient and information cannot be spoon-fed.  It must be the individual, whether an obese person, or an inner city pupil, that must be engaged and motivated with adequate guidance and support from healthcare providers and teachers respectively.

I usually write about wireless technologies which are patient-centric and will result in lower cost of better care delivery. Similarly, the cost of motivating a student comes at a lower price than the resources harnessed to enforce the ‘No child Left Behind’ test-focused outcome legislation. Technology may be an important key to both the medicine and educational crises.  Wireless technologies have already been seen to result in better outcomes utilizing fewer resources in such diseases as diabetes. One example in education is computerized program called the Khan Academy, utilized in the classroom along with the teacher, which shows promise in captivating the attention and improving learning. Let engagement of both the patient and student become the paramount goal and success will follow.  The voices of forward thinking leaders and a commitment to improvement are needed. There will be pain points on both fronts, but it won’t be as painful as the embarrassment of being a financially poorer country with third world services.

David Lee Scher is a former cardiologist and a consultant at DLS Healthcare Consulting, LLC.  He blogs at his self-titled site, David Lee Scher, MD.

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