The orientation to the patient: a health service as a "service"

Sophia Schlette

One year ago, while I was still working for Kaiser Permanente, I was invited to give a talk on primary care concepts in an adult education academy in the vicinity of Berlin. I thought I would present a theoretical framework of evaluation, based on evidence, consisting of ten dimensions, similar, but not identical, to the ten building blocks of Bodenheimer already presented in this blog. I arrived on the previous afternoon and saw the participants with a certain air of frustration in being saturated with so much theory. The models and concepts of the talk had little to do with the experience in the German medical practice or with the doctor-patient relationship in real life. In Germany, if you go to the doctor, you have to take half a day off. Wait up to 40 minutes, despite having an appointment just to have 5 precious minutes with the doctor. Typically, neither the doctor nor his employees will give any explanation, nor apologize for the delay. There is no electronic medical record everywhere and where there is, the doctor begins to read it only when the patient is present: “Here’s the recipe. Have a good day. Goodbye” This is the German system, as we know it since childhood.

HealthConnect: an electronic health record oriented to value

HealthConnect is Kaiser Permanentes’ name for their electroni health record (EHR), but first allow me to give you a brief presentation of this American insurance, so admired among health managers specially the European ones.

Brief overview of Kaiser Permanente

In 1933 Dr. Sydney Garfield established a prepaid health plan model for workers on an aqueduct in California’s desert. Later, in 1938, Henry Kaiser persuaded Dr. Garfield to extend the experience to other groups of workers, both in California and Washington. Immediately after the war ended, in 1945, the Kaiser-Garfield health plans opened to the general public. These health plans were based, in the beginning, on a reciprocal prepaid model, a care group practice, a population view of prevention and shared clinical information. This pattern contrasted sharply with other policies, in a country that represented and continues to represent the epitome of payment per service.

Today, Kaiser is an insurance that functions through a stable agreement with a doctors’ company called Permanente. It has 9 million members in 9 states, 36 hospitals, 533 health centres, 170,000 employees plus 16,000 physicians in Permanente, a budget of $48,000 M and $2,000 M of benefits (2011).