The chat #OccupyHealthcare occurred on Sunday November 6, 2011 at 9pm ET.
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| Participants in First #OccupyHealthcare Chat |
People from around the world, but primarily from the United States, answered questions. There were 1,187 tweets during this chat. To analyze the content a systematic process has been used to identify themes and perspectives. The following is a preliminary report on the chat.
Questions were asked by four moderators timed to occur at regular intervals over the course of an hour. The first question asked:
Why do we need to Occupy Healthcare? What are the problems, what are the reasons we need to act, and why now? Is there a need to Occupy Healthcare? Is there any urgency?
Themes noted in the discussion included:
:
1. Everyone deserves access to a health care
a) Need a healthcare systems that values humanity and individuality of patient and provider
b) Healthcare system needs to have patients at the center
2. Healthcare in US costs too much
a) Most bankruptcies are health related
b) People have to choose between healthcare or groceries
c) People are losing their homes to pay for healthcare
d) Cutting the safety net while enacting reforms not good
3. Healthcare system should support and promote health
a) Prevention is not emphasized
b) Social determinants are not addressed
4. System is fragmented requiring patients to coordinate care
5. System of payment is inappropriate
a) For-profit model does not work
b) Emphasis is on volume of patients seen, not value of the experience
c) Physicians and hospitals are paid to provide unnecessary care
d) Providers and vendors make money on the number of transactions and not patient support
e) Treating patients is more profitable than finding cures or prevention
6. Money in the system is poorly managed
a) Health care executives are making multimillion dollar salaries and benefits
b) Malpractice insurance raises costs of providing services
c) Fear of litigation increases likelihood of excessive testing and services
7. Health insurance
a) Health insurance is not insurance
b) Health insurance, no matter the carrier, is expensive and doesn’t cover costs of healthcare
c) Health insurance should not be for-profit in design
d) Since health insurance is expensive, many are uninsured or underinsured
e) Health insurance reform is not healthcare reform
f) Coverage should not be based on employment status
g) Coverage should not be based on immigration status
8. Medical industry is the voice lobbying in politics and government. Patient and providers need to take it back
9. Charity and compassion for others is part of the rent one pays for being on earth
The second questions asked participants to come up with goals for a movement to change healthcare system.
Patterns in the responses included:
1. Change from the present “illness for profit” corporate system
2. Insure that all have fair and equal access to care
3. Build alliances among people who are driven to build better healthcare system
4. Give scholarships for primary care physicians
5. Increase communication in healthcare setting
6. Silos of excellence with brilliant caring physicians and researchers need to be generalized so that all can receive quality care
7. Increase patient and provider influence: Make them the voice lobbying in politics and government
8. Legislators receive same healthcare experience as constituents
9. Define quality healthcare metrics: What is “good healthcare” in the primary care setting
10. Educate public that providers, physicians, nurses etc. are exhausted and feel demoralized by the system as well For example:
a) “#occupyhealthcare do you think you can make me think? Make me work? Make me your slave...AND then keep you healthy? Good luck.”
b) “I was overwhelmed, trying to coordinate care, treatments, bills, insurance, etc. we must improve!”
The third question asked participants to provide some practical steps to achieve the goals.
1. Change Medical education
a) Medical school tuition must be lowered to give those who are disadvantaged a better chance to become doctors
b) Embed community engagement in primary care residency programs to train physicians to advocate for social determinants
c) Teach person-centered care
d) Integrate mental health education and public health education into primary care teaching
2. Join already created coalitions who have been “fighting the fight” for years
3. Inform patients of their choices and help them advocate for themselves
a) Utilize proper analytics to assist and grow health literacy
b) Promote data-informed health decision
c) Educate patient, family and physicians of the need for end of life discussion before this time, since 50% of healthcare money is spent in the last 6 months of life
4. Physicians need to take a lead in their organizations and need to be willing to initiate culture change
a) Inform physicians of the need to reduce industry influence and propose responsible change
5. Meet with legislators. Meet with corporate executives. Make noise. Get involved in the process
a) Identify policies and forces beyond healthcare that impact health
b) Social disparities affect health—work on policies that affect food, housing, social inequality.
c) Remind corporate executives who run the hospitals they won’t run without health care providers (physicians, nurses, etc)
d) Get academics out of the centers and into Town Hall meetings in communities
e) Help patients register to vote
f) Fight for Patient Protection and Affordable Care Act to be enacted
g) Become active in policy discussions with students, peers and friends. Point out injustice when seen
6. Reform payment structures for health care, primary care, wellness, and mental health care
7. Assure access to experimental and ancillary care for those with rare or extreme illnesses such as cancer
8. Move the dietary guidelines from the USDA to the CDC or IOM
9. Establish outpatient clinics near every hospital funded by the Federal government to serve indigent populations
10. Reduce direct-to-consumer advertising by pharmaceutical industry
11. Reduce the paperwork
Tonight we are going to continue the conversation. Please join us at #hchlitss on Thursday, November 10, 2011 at 8pm ET.
