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Placing Health Care under God's kingdom...

TRANSFORMING THE BAHAMAS "SICK CARE SYSTEM" INTO AN OPTIMAL HEALTH AND WELLNESS LIFESTYLE

 

This data is used from the Organization for Economic Cooperation and Development and other sources to compare health care spending, supply, utilization, prices and quality in 13 industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The U.S. spends far more on health care than any other country. However, this high spending cannot be attributed to higher income, an older population, or greater supply or utilization of hospitals and doctors. Instead, the findings suggest the higher spending more likely due to higher prices and perhaps more readily accessible technology and greater obesity. Health care quality in the U.S. varies and is not notably superior to the far less expensive systems in the other study countries. Of the countries studied, Japan has the lowest health spending, which it achieves primarily through aggressive price regulation. Health care spending is a key component of any industrialized country's economy. It provides a major source of employment, often for highly skilled workers and in rural areas without other significant industries. In addition, the development of drugs and medical technologies can lead to breakthrough products, innovation hubs, and new markets. Most important, health spending satisfies fundamental individual and social demands for services that bring improved health, greater productivity, and longer lives. Compared with most other sectors of the economy, a large share of health care is publicly funded. In all industrialized countries, with the exception of the United States, health care affordability is ensured through universal insurance-based or tax- financed systems. In the U.S., public funds contribute to health care through insurance programs.

 

"IN SHORT THE BAHAMAS HEALTHCARE SYSTEM NEEDS A NEW MODEL THAT MAKES THE EXISTING FAILED MODEL OBSOLETE"

 

Most medical doctors in the western hemisphere believe that a person with a chronic disease or chronic ailment can't become well because they're "chronic." It's a circular reasoning fallacy. The word "chronic" refers to the duration of the condition, or disease. It has nothing to do with permanency, but the medical doctors can't get over their own beliefs. Instead of admitting failure to help a patient get well, they label the patient as "chronic." They believe that the patient can't get well, and conveniently absolve themselves from blame. Let's not call these doctors idiots or imbeciles, because they are otherwise people who know how to reason. However, let's understand that the doctor's strongly held personal beliefs about chronic conditions are largely based on the opinions of their teachers who had the same failure rate with their own patients, over 40 years ago. Outdated Beliefs, Passed-on through Medical School The myth of the chronic disease not being able to improve is part of a medical indoctrination, passed-down in medical schools, over many decades. Holding these false, passed-down beliefs is why medical doctors fail for their "chronic" patients. MD's don't have enough time to challenge their own biased beliefs. They have no time to investigate, or do any research on their patient's behalf due to their over-booked daily patient load. More than 50% of Bahamians have a chronic condition. A chronic condition is defined as 3 or more months with an illness, ailment, or disease. Chronic allergies are allergies lasting 3 or more months. Chronic constipation is 3 or more months of constipation. Irritable bowel (IBS)? You get the idea, right? "Chronic" means it has been present for a while and that nobody has found the solution yet. It doesn't mean there is no solution for more than 50% of people who have a chronic disease! Many medical doctors have a problem communicating with you when they don't know the answer to your questions, such as: Is there any other doctor that can help? What else can be done? What about alternatives? Instead of answering these questions openly and honestly, and saying that they don't know, they tell you that nothing else can be done.

 

Based On Experience of "More Of The Same" You must understand that the doctor's response to your questions is based on that doctor's limited experience, and limited knowledge. The doctor should be referring you to someone else to handle your care, but instead the doctor tells you his doomsday beliefs; that he thinks you can't get well. It is a guarantee of failure to get well, if you would just follow his plan. When a medical doctor, who believes in old myths about chronic conditions, tells you he or she thinks nothing else can be done, you don't have to believe it too. You have to do your own research. Know this fact: medical doctors have an inferior education regarding clinical nutrition, and functional medicine. Your medical doctor has no clue what else can be done outside of his or her own specialty (drugs and surgery). Your doctor may have blinders on, and you have likely never consulted with anyone other than an MD, so you don't realize that your doctor's opinion is just an opinion; not a fact. Remember, an MD who gives you the old myth about people with chronic conditions not being able to get better is basing that opinion on his or her own indoctrinated beliefs and his or her failures as a doctor (experience). Do you go to a doctor so that he or she can fail for you? I didn't think so. It's time to step out of the familiar types of medical practices you have frequented, to a doctor who practices with a scientifically based, alternative medicine model.

 

Your new alternative doctor must use a different model of practicing, otherwise you will get more of the same. Your new doctor can use current science instead of old medical beliefs that were taught by medical school doctors from 40 years ago. "The path to health for Bahamian citizens and fiscal health for The Bahamas is through new emphasis on wellness, disease prevention and an integrated public healthcare system. It is time to make this the centerpiece of our nation's healthcare reform". Although Bahamians pay more for medical care now than any other time in our countries history, problems abound in our health care system. Unsustainable costs, poor outcomes, frequent medical errors, poor patient satisfaction, and worsening health disparities all point to a need for transformative change. Simultaneously, we face widening epidemics of obesity and chronic disease. Cardiovascular disease, cancer, and diabetes now cause 70% of all deaths and account for nearly 75% of health care expenditures. Unfortunately, many modifiable risk factors for chronic diseases are not being addressed adequately.

 

A prevention model, focused on forestalling the development of disease before symptoms or life-threatening events occur, is the best solution to the current crisis. Disease prevention encompasses all efforts to anticipate the genesis of disease and forestall its progression to clinical manifestations. A focus on prevention does not imply that disease can be eliminated but instead embraces a model of "morbidity compression," in which the disease-free life span is extended through the prevention of disease complications and the symptom burden is compressed into a limited period preceding death. Thus, a prevention model is ideally suited to addressing chronic conditions that take decades to develop and then manifest as life-threatening and ultimately fatal exacerbations. Although the need for a prevention model was never highlighted during the recent health care reform debate, efforts to expand prevention continue to be thwarted by a system better suited to acute care. A century after the Flexner report, the acute care model and its cultural, technological, and economic underpinnings remain securely embedded in every aspect of our health care system.

 

The organizational structure and function

 

The Bahamas medical system is rooted in fundamental changes made at the beginning of the 20th century that emphasized an acute care approach and marginalized prevention and public health. Breakthroughs in laboratory sciences led by Koch and Pasteur provided powerful tools for mechanistically understanding and treating infectious diseases. Bolstered by philanthropy and the Flexner report, Western Medicine became reliant on laboratory research. This strategy made sense 100 years ago, given the prominence of acute infectious diseases in a young population; but it makes little sense now. With the aging of the population, the shift in the burden of disease toward chronic conditions has accelerated. The most prevalent preventable causes of death are now obesity, cardiovascular disease, hypertension, arthritis, chronic inflammation and smoking, which result in delayed but progressive disease. Even in the developing world, increases in the prevalence of chronic disease are outstripping reductions in acute infectious diseases. Such epidemiologic evolution demands a focus on public health and prevention. Yet economic and technological factors dating from the early 20th century remain strong barriers to effective disease prevention.

 

A key feature of The Bahamas current health care is its use of a piecemeal, task-based system that reimburses for "sick visits" aimed at addressing acute conditions or acute exacerbations of chronic conditions. Economic incentives encourage overuse of services by favoring procedural over cognitive tasks (e.g., surgery versus behavior-change counseling) and specialty over primary care. The current model largely ignores subclinical disease unless risk factors are "medicalized" and asymptomatic persons are redefined as "diseased" to facilitate drug treatment. These mismatched economic incentives effectively preclude successful prevention through health maintenance. Moreover, our reliance on ever newer, more advanced technology has perpetuated an expensive system in which costly new technology is widely adopted in the absence of comparative advantage. When combined with economic incentives for patenting devices and drugs, these technological factors become self-reinforcing. Although many preventive strategies may be cost-effective, they unfortunately have limited potential for wide adoption because they cannot be patented or made profitable. Therefore, the primacy of patentable therapies impedes research on prevention and diffusion of prevention approaches that could cost-effectively address the burden of chronic disease. The cultural and social underpinnings of our current system also inhibit optimal disease prevention. Faith in reductionism, which was infused into medicine in the 20th century, has empowered medical research to pursue only isolated problems and to yield targeted, immediately deployable solutions.

 

Consequently, the model for treating acute infectious disease is being misapplied to the treatment of chronic disease. For example, cancer chemotherapy is modeled after antibiotic therapy, and coronary revascularization is modeled after abscess incision and débridement. Societal expectations of a "magic bullet" and a focus on symptom relief also reflect and reinforce the reductionist approach. These scientific and societal values emphasize discovering a "cure" for the major causes of death. With the advent of direct-to-consumer advertising for pharmaceuticals and surgical procedures, these cultural expectations of immediate, simplistic solutions have been bolstered by consumerism and fully exploited to generate demand for therapies that are marginally indicated and potentially unsafe. Our very culture thus devalues disease prevention. Changing the system requires recognition of these cultural, technological, and economic obstacles and identification of specific means for overcoming them through alterations in medical education, medical research, health policy, and reimbursement. For example, to combat the primacy of technical knowledge and the profit-based system for medical technology, medical schools must teach prevention strategies alongside treatment approaches and emphasize motivational interviewing with a focus on lifestyle modification. Insurance providers and the Bahamas Government must fully reward use of appropriate non-patentable therapies and support research on the development and dissemination of prevention strategies. To change our reductionist way of thinking, we must teach aspiring physicians about systems science that addresses psychological, social, and economic determinants of disease. Taking a patient-centered, whole-person approach focused on long-term functional status will also help to address the current fragmentation of care and allow for standardization of prevention strategies. Medical school curricula does not, but should emphasize homeostasis and health, rather than only disease and diagnosis, and provide training in the science and practice of cost-effective health promotion. In turn, payers will need to reimburse for health maintenance and prevention activities, primary care physicians will have to act as health coaches, and all health care professionals will need to embrace a coordinated multidisciplinary team approach. Systematic steps must also be taken to change the culture of medicine so that primary care is valued.

 

Renewing primary care will require increasing ambulatory care training in community settings and reallocating funding for residency training away from hospitals to reimburse appropriately for innovative models such as medical homes. Furthermore, we must compensate primary care physicians for their work as care coordinators by establishing reimbursement parity for cognitive and procedural care and accounting for long-term costs and benefits. The new approach to medicine endorsed by the Flexner report succeeded because it was based on sound science and a radical restructuring of the way medicine was taught, organized, and practiced. Today, we face a similar challenge that requires another fundamental reordering of our health care system. Although the need for acute care will remain, centering our efforts on prevention is the only way to thwart the emerging pandemic of chronic disease.

 

Current health care reform efforts will bring incremental improvement, but reengineering prevention into health care will require deeper changes, including reconnecting medicine to public health services and integrating prevention into the management and delivery of care. Though change is painful, the successful transformation of medicine at the turn of the last century shows that it is possible. Ultimately, embedding prevention in the teaching, organization, and practice of medicine can stem the unabated, economically unsustainable burden of chronic disease. The problem with our health care system: no one is looking at root causes of the system's problems. Instead, we are tinkering around the edges rather than addressing the underlying assumptions in order to transform the system from sick care into genuine health care.

 

What are the root causes of the problem?

 

Let's consider these realities: 1. Our system focuses on disease, not on wellness. Less than two per cent of our health care dollars go into maintaining health and preventing disease. 2. We focus on curing, instead of healing, even though 75% of our dollars are spent on chronic diseases for which there are no cures. 3. Financial incentives are for tests and procedures, not health outcomes. 4. We do not treat the whole person, failing to harness the healing powers of the body, mind and spirit. 5. We intervene late in the course of disease progression, when illness is less reversible and the cost of treating it is far greater. 6. Productivity standards such as reducing physician time per patient visit discourage physicians, nurses and hospitals from taking the time to get beneath surface symptoms to the deeper causes of patients' problems. Physicians today average only seven minutes per patient. 7. Patients are encouraged to be passive recipients of their health professionals' ministrations, as the medical system does not emphasize patient empowerment and partnering. Yet lifestyle behavioral choices influence the trajectory of chronic illnesses. A new approach is required, one that focuses on the whole person and empowers people to take responsibility for their health.

 

Called integrative medicine, this approach focuses on wellness and preventing illness while integrating the best elements of conventional medicine with complementary therapies drawn from other healing traditions. Integrative medicine is patient-centered, emphasizing partnership and collaboration between patients and health professionals and offering genuine choices in healing. Rather than looking at the patient as a diseased body part, integrative medicine sees a whole person, connected in body, mind and spirit with immense powers of self-healing. It believes that all aspects of patients' lives need to be addressed in order to become and stay well. It emphasizes new models for treating chronic illness, recognizing that episodic care is an expensive and ineffective revolving door. Concurrent with this shift in focus, we need fundamental changes in the way health care is reimbursed. There is essentially no reimbursement for maintaining health and preventing disease, and few limits on payments for treating disease. In most instances co-pays are so small that they have little or no influence on health behaviors of individuals. This must change, or we will continue on an ever-upward spiral of cost escalation until as a nation we simply cannot afford quality health care.

 

What is the cost impact of integrative medicine? We believe integrative medicine will deliver more effective medicine at a lower cost than current care. By preventing or delaying the onset of chronic diseases, the cost of treating chronic disease will decline. By doing what they can for themselves, people with chronic conditions will be better equipped to avoid recurrences. To bring about these changes in behavior, the nation's leading insurers should work together with leaders in integrative medicine to pilot innovative reimbursement programs to address chronic conditions holistically. For example, chronic pain, diabetes and heart disease are three conditions that offer immediate opportunities to use integrative approaches to demonstrate improved patient outcomes and cost reductions. We are nearing the tipping point when the evidence of the benefits of integrative medicine will become so clear that "the new medicine" will be recognized as the best – and only sustainable – approach to addressing the root causes of the health care crisis. By adopting this new medicine, we have the opportunity to heal the healthcare system itself.

 

THERE WILL BE

 

SEVERAL NEW INITIATIVES INTRODUCED

 

Organizations The Bahamas Agency for Therapeutic Products, will be a public institution of the Bahamas government. It will be similar to the Bahamas Drug Agency. The legal basis of this Agency is the Bahamas Act on Natural Medicinal Products and Medical Devices (Therapeutic Products Act - TPA). The new area of responsibility takes into account the growing demands for international health protection and quality standards, on the use of Natural and all Indigenous Medicines, in the public system. The Bahamas Agency for Therapeutic Products will be financed from fees, payments from the Bahamas government in return for services of public interest and from services rendered to third parties. The public services will be described in a service mandate from the TPA Council and in an annual service agreement with the Ministry of Health and Wellness. To ensure the efficiency of its control activity, the Agency will be managed according to the principles of good business practice.

 

THE ORGANIC FARMING ACT/RESTORING OUR NATION TO HEALTH

 

The Bahamas will seek Organic Equivalency Arrangements between nations that will streamline organic trade, strengthen organic agriculture and support jobs and businesses on a global scale. The Bahamas organic industry will make significant progress under this New Administration, this will be another chapter in the success story of organic agriculture, providing new economic opportunities for Bahamian producers, choices for consumers, and jobs in rural communities across the country." A New and Innovative Marketing Service will assist Bahamian Local farmers and businesses to create an industry that can work in partnerships with our neighbors to the North, who today encompasses over 19,000 organic businesses and accounts for $39 billion annually in U.S. retail sales. Since the beginning of the Obama Administration, the United State has signed five organic equivalency arrangements. Arrangements with Canada, the European Union, Japan, and Korea, U.S. organic farmers and businesses have streamlined access to over $35 billion international organic markets. When combined with the $39 billion U.S. organic market, these arrangements have doubled the organic market access for U.S. organic farmers and businesses.

 

The Bahamas Organic Farming is an important step in strengthening our economic relationship with likeminded countries in Organic Farming, in one of the fastest-growing segments of the agriculture economy. The opportunities that can be provided by the arrangement will build on this trend and yield important benefits for producers and consumers alike. It is our intent to have local technical experts to conduct thorough on-site audits to ensure that our regulations, quality control measures, certification requirements and labeling practices are compatible with The United States and Europe. These new partnerships will reflect the integrity of our National Organic Program and rigorous organic standards of the United States USDA's and the European Union.

 

 

 

 

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