* The Plan's emphasis on preventive medicine. Patients covered under the plan wouldn't just be invited to come in for yearly check-ups. The plan requires them to go through a series of initial tests and to follow up with also hire a staff of recruiters who will spend their time rounding up patients for preventive treatments;
* The plan's increased use of non-hospital medical care. The real burden of medical expenses falls on hospitalized patients. The Health Plan will try to do as much out-patient and ambulatory treatment as it can to dodge the high hospital rates;
* The plan's reliance on group treatment instead of the traditional family-doctor technique. A core of specialists will man the center and treat Health Plan patients.
The cumulative effect of all these changes may not be instantly clear to the layman. But it certainly is clear to Pollack, who is now in charge of deploying the plan in Boston. Citing an impressive set of figures, Pollack is able to show how the health plan can offer better medical service at a lower total price.
THE Health's Plan's coverage will be far more complete than average insurance plans; the Health Plan will include doctor visits (at $1 apiece), complete hospital care (virtually free), and many other services. Few insurance plans come near that, but insurance rates are still high. Pollack admits that the Health Plan's fee might be slightly higher than current plans like Blue cross, but he adds an explanation of how each new element of his plan will save money.
The shift to pre-payment of medical costs is part of the Health Plan's drive to get healthy people to come in to the center. Knowing that the visits are paid for may knock down some of the psychological barriers that would keep patients from coming in for examinations. And Pollack sees little danger in this new influx of patients to his health center.
"We hope they'll come in regularly, get to know their Physician well," he says. When people join the plan, they will have a thorough examination. In the unstructured way that most Americans guard their health, five or ten years may elapse between exams. Under the health plan, however, the aim will be on constantly-supervised care. The initial exam--accompanied by a barrage of "screening test"--may be able to pick up many potential problems long before they erupt. From the beginning, health plan physicians will emphasize nipping illness while it's easy to nip instead of waiting for the kind of full-scale disease that requires a trip to the hospital.
From the basic plan of regular examinations, a series of baroque innovations is possible. Pollack says that the health centers may develop a data bank with vast amounts of data on thousands of patients. "From this data base," he says, 'we can get a reading of the tests end eventually use test results as a predictive medium."
Another important aspect of the plan is its firm emphasis on group practice. Ten years ago, a subcommittee of the AMA denounced the trend towards creeping groupism as a danger as great as "socialized medicine." But the group mode has won reputability since then; and more important, it has shown in practice that it is far more efficient than single-doctor treatment.
Medical statisticians have run studies comparing group practice plans with normal family doctor care. What they've found is that patients who use institutionalized groups practice facilities -- like California's private Kaiser Plan clinics--spend much less money on health care than do patients of single physicians. The saving may come because each doctor can see more patients; or it may be because the cluster of specialists make preventive medicine more effective. But clear. Each medical care dollar goes farther when spent in group-practice clinics.
THE FINAL part of the Health Plan's drive on medical costs come with its elaborate plans for "outpatient" services. Since hospital care costs -- the "impatient" expenses of medical jargon -- are easily the most expensive component of medical care one good way to trim costs is to keep people out of the hospital. Coupled with the health plan's drive for prevention will be its attempt to treat its patients in the center, instead of sending them off to the modern--and costly -- hospital.
Pollack doesn't contend that outpatient care can be a complete substitute for hospitalization. The health plan won't try to perform surgery in back rooms of its health center. But Pollack claims that about one third of the patients in a hospital on any given day do not medically need to be there. They no longer need the 24-hours care the hospital provides; and if adequate outpatient clinics were available, the patients could recover at home, making occasional visits to the clinics.
But few areas have decent outpatient facilities, and so marginal patients fill the hospital beds. By providing a center with intensive outpatient and ambulatory care facilities, the health plan hopes to clear the hospitals of the people who should not be there.
As some liberal observers se the health plan, however, all these efficiencies still leave some gaps. The plan's new benefits seem to be aimed at the same middle-class consumers who now buy medical insurance through private agencies. The similarity is no accident; Pollack says that the plan was deliberately contrived to work within the existing private carriers. But some critics have charged that this plan really doesn't solve the distribution dilemma: it offers better service to America's insurance-buying suburbanites, but it seems to turn down the urban an rural who can never scrape together insurance premium payments.
This is where the health plan's projections for enrolling Roxury's poor become important. Tomorrow's installment will discuss how the poor will be covered at Harvard; why Pollack thinks a mixed middle-class/poor clientele is better than a program aimed only at the needy; how Harvard hopes to set a precedent for the nation; and how the Harvard Health project came into being.