Health care vs. car care

My grandma is sometimes inclined to talk about her body as if it were an aging jalopy.

New knee, new cornea - it's all fine by her, she says, just so long as they keep making the parts.

Which always makes me wonder: What if our health care system was set up like an auto shop?

When I take my car in for repairs, it doesn't matter if something's wrong with the carburetor or the electrical system. My mechanic takes care of the whole car. Even if he doesn't actually fix every problem, he makes sure it gets done.

He sends me a postcard when it's time for a tuneup, reminds me not to go too long between oil changes, helps me avoid costly catastrophic repairs.

But when I go to the doctor, it's more like a scavenger hunt - tests here, specialists there.

I go when I'm sick or when something hurts. My annual checkups are brief and businesslike. My doctor doesn't get reimbursed for helping me manage my health.

She does her best, of course. She answers my questions when I think to ask them. Experts say Iowa's providers do a better-than-average job of providing patient-centered care.

But they do so despite a system that doesn't reward doctors who try to keep you healthy.

In the U.S., only about one-third of our doctors are primary care physicians. The rest are specialists.

In countries where health care is better and costs less, those numbers are reversed.

A lot of people think focusing on primary care and changing the way we pay for care would help save money and improve our health here, too.

The idea of a patient-centered medical home isn't new, but it is

generating a lot of buzz lately.

Last week, about 100 people from Iowa's health care community came to Coralville to talk about the idea at a symposium, put together by the University of Iowa's Public Policy Center and the College of Public Health.

The consensus seemed to be that we have to get rid of fee-for-service payments and give doctors more incentives to keep their patients out of the hospital.

Pay doctors for coordinating care, for spending time in consultation, for keeping in touch with patients between visits.

Pay them for results, not for racking up tests.

Even though chronic illness counts for 75 cents of every dollar we spend on health care, it's an afterthought in our current system.

What if, instead of towing us in and patching us up when we break down on the side of the road, doctors were paid to keep us well?

Jennifer Hemmingsen's column appears on Wednesdays and Saturdays. Contact the writer at (319) 339-3154 or jennifer.hemmingsen@gazcomm.com