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Thursday, March 1, 2018 12:20 am

From Honduras to health care reform

SIU’s Dr. Jerry Kruse thinks deeply about big changes in the U.S. health system

Dr. Jerry Kruse on a 2009 visit to Honduras as a medical volunteer. His several visits to Honduras were organized by Global Brigades, which calls itself “the largest student-led movement for global health.”
When Dr. Jerry Kruse headed to Honduras in 2005 to volunteer, he thought he was going on a simple medical mission trip to a rural village devastated by Hurricane Mitch. Instead he discovered a hurricane of ideas and organization that gave him a vision for reforming the U.S. health care system. Kruse, who for many years was chair of the Department of Family and Community Medicine at SIU School of Medicine, became the school’s dean and provost in 2016.

In Honduras he met Sister Maria Rosa Leggol who presided over a network of orphanages, hospitals and medical practices under the umbrella of Sociedad Amigos de los Ninos – friends of the children. She had become a champion of public health in rural villages, and insisted each town her organization served have a community health worker to take on a list of tasks, including tracking illnesses and making sure people get to their medical appointments. In one village, Portrero Grande, Kruse watched as a young man named Jaime volunteered, saying, “I have the fire! I have the desire!”  In subsequent annual visits to Honduras, Kruse tracked Jaime’s organizing success, and by the third year learned he was in Tegucigalpa training others to be community health leaders.

A decade later those ideas from Honduras helped to form the Access to Care Collaborative in the Enos Park neighborhood of Springfield. In October 2015, SIU with Memorial Medical Center and HSHS St. John’s Hospital, launched the program in the 36-square-block neighborhood. Over the next two years the program’s director and two community health workers helped people in the neighborhood arrange doctor visits and get health insurance, even groceries and housing when the need arose. During that time the group’s physical health index increased by 25 percent, emergency room use decreased by 34 percent and police calls to the neighborhood decreased 22 percent.

Now Kruse wants to include non-physician community health workers as a mandatory part of national health care reform. Two programs the Illinois Medicaid system tried years ago – Illinois Health Connect and Your Health Care Plus – managed to save the state hundreds of millions a year by providing medical “homes” for recipients and developing care plans for the highest risk, highest cost beneficiaries. Those programs have fallen by the wayside under current Medicaid rules. “I don’t know how poorly the system would have to perform or how much it would have to cost before we took that step,” Kruse laments. “It would probably be really difficult in the current political climate.”

The current political climate doesn’t deter Kruse from planning, promoting and educating about what a better U. S. health care system would look like. As he told the World Affairs Council of Central Illinois in his Feb. 1 lecture at UIS, the U.S. needs to adopt one system rather than the four it has now. The four are: 1. The Third World system – the 29 million in the U.S. with no health insurance. 2. Socialized medicine as in Britain and Japan with government-employed physicians – like the Veterans Administration. 3. Medicare system as in Canada – Medicare and Medicaid now cover 127 million in the U.S. 4. Private insurance as in Germany, where insurance companies are nonprofits. Private insurance covers 145 million in the U.S.

Nobody wants a Third World system and British-style socialized medicine won’t fly politically. Kruse favors Medicare for everybody. “That would work,” he said in an interview. “Medicare has been a highly successful system. It’s very efficient. Medicare pays SIU Medicine in 30 to 35 days. Health outcomes for seniors is the best performing sector here by far. For those it covers, satisfaction with Medicare is very high.”

A “high supply” of primary care is another element of the U.S. health care system Kruse envisions. Currently there aren’t enough family medicine doctors to see all the patients who need them, and not enough medical students are going into primary care. The shortage of physicians is directly related to the fact that primary care physicians earn only about 60 percent of what specialists make. If primary care earnings could be increased to 80 percent of specialists, about 40 percent of students would choose careers in primary care and the doctor shortage would be alleviated.

“We can’t go on with the system we have,” Kruse said. “It’s just untenable.” Studies show about half of outpatient visits to specialists would have been better treated by primary care physicians. Availability of more primary care doctors could decrease pressure to see more patients, increasing job satisfaction. Even specialists would be happier if they could focus more on their higher-level specialties, Kruse said.

SIU and other health care providers continue to experiment with ways to improve the system, and some states are trying new programs to see what might work. But Kruse grows impatient with continual experimentation. “We’re flailing around because we have so many people doing so many different things,” he said. “We don’t have a mechanism for regional or national health care planning to set some of these things as standard. I don’t know to what point we need to get to before we change.”

With millions still without health insurance, and costs growing for those who have it, the situation could deteriorate into a national security problem, Kruse said. And that could require an effort of the scope of the interstate highway system, which President Eisenhower promoted as important to national defense. Rather than merely improve the existing highways, he pushed the nation to make the difficult decision to build the optimal system. “Rather than coming up with 1,000 different solutions,” Kruse said, “we must make our best effort to develop a comprehensive health care system.”

Fletcher Farrar is editor and CEO of Illinois Times. Contact him at illinoistimes.com.

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