The Affordable Care Act and the Missing Accountability

The Affordable Care Act added new accountabilities for many players within the health care system.  This includes Accountable Care Organizations (ACOs), hospital systems, health insurance providers, state medicaid agencies, and others.  The one accountability that appears to be missing is that related to the patient or individual.

Many years ago, when taking one of my children to their health care provider, I noticed a sign that stated simply, "There is nothing that the doctor can do to make up for what the patient will not do."

Most of us in health care have found this to be true.  If the physician diagnoses a condition and prescribes a medication, that medication does not work unless the patient gets the prescription filled and takes it appropriately.  Many other examples exist, including patient exercise, appropriate diet, etc.  For health care delivery to be effective, the patient needs to be involved and accept accountability for their behavior and its impact on their health.

Many employers and health insurance providers have been working to increase patient or individual accountability.  Many techniques have been or are being used, including copayment reductions, premium adjustments, and others.  When used appropriately, methods to increase patient or individual accountability have been shown to improve the involvement of the individual and the subsequent health outcome.

However, in the Affordable Care Act, patient or individual accountability was forgotten or neglected.  Instead, the bill was written to decrease the accountability of the individual.  If the individual does not want to pay a full premium, they can wait until they need care and then pay a small penalty.  If the patient wants preventive care, they do not need to decide if it is appropriate for them and efffective for their specific case, they can get this care at no cost.  If a patient is seeing a physician in an ACO, but does not want to follow their recommendations, they can see a physician outside that ACO, and the physician now bears financial risk, not the patient.

I hope that as future legislation and regulations are considered that some focus will be on increasing the accountability of the individual, thus encouraging them to be a more active participant in their health delivery and the subsequent outcomes.