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Fundmental health care change is inevitable

Dear Editor:
Some Rochesterians believe our health care system will remain untouched because federal health care reform died on the operating table last year. However, it is important to recognize that major changes in health care will occur with or without legislation.
Historically, Rochester has succeeded in providing wide access to medical care and keeping health care costs down. Since both of these issues were at the core of the contentious reform debate, Rochester gained national attention. Yet, we cannot rest on our laurels; factors outside of legislation will cause the face of health care to change dramatically over the next few decades. Rochester’s residents, businesses and health care providers should be prepared to deal with this fact without sacrificing the needs of our community.
From the mid-1960s until the start of the 1990s, U.S. health care costs rose rapidly. For many years, Rochester has kept its medical-cost increases below those experienced elsewhere in the country. This is largely due to cooperation among hospitals, physicians, insurers and other health care providers. In addition, the managed-care programs that are integral to the local delivery of health care services have helped to hold costs down.
Despite the benefits cooperation brought us in the past, it is possible that the cooperative atmosphere in the Rochester market may not survive in the changing health care environment. Like those in other parts of the country, Rochester providers may take a more competitive stance in marketing their services. The trick will be finding ways to compete without sacrificing quality and accessibility of care.
An alternative to a competitive health care model might be the development of an incentive-based community delivery system. In a system of this nature, physicians may be established as the controllers of total local health care expenditures, with rewards/incentives for using health care resources in the most cost-efficient manner. There are numerous benefits to this type of system, including less waste of health care resources and greater cost containment.
One of the biggest trends altering the face of health care here and across the nation is integration. Many providers are joining forces to begin to develop integrated delivery systems and multispecialty group practices of physicians. Such practices make it easier for patients to access comprehensive medical services by bringing together all types of health care.
Consumers’ greatest concern continues to be how to pay for health care. During the debate, the most volatile issue was who should carry the greatest financial burden: government, businesses or consumers. Some businesses are working out ways to share the burden with employees who are willing to pay for part of their health insurance in exchange for other benefits, such as child care or flexible hours.
In conclusion, Rochester needs to recognize that, no matter how health care reform plays out, change is inevitable. The key is to find the best way to improve or redesign our health care delivery system without sacrificing the favorable features that fostered its nationwide reputation as a system that works.
Mario P. Urso
Partner, Financial Services Division
Bonadio & Co. LLP


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