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UT System Executive Vice Chancellor Kenneth Shine Discusses Health Care Reform at School of Nursing 25th Anniversary Symposium
In "Health Care Reform: The Possible and the Probable," University of Texas System Executive Vice Chancellor for Health Affairs Kenneth I. Shine, M.D., took his audience through an informed, analytical and often humorous overview of health care and its future from the perspectives of all stakeholders-individuals to institutions.
Changing his name and title to fit the point of view, he was variously an emergency room patient, employer, pharmaceuticals company spokesman, physician, insurer, union member, academic leader, voice of technology and nurse as he completed the picture of who gets what, who pays for it and where it all may lead.
The presentation was part of the two-day celebration of the 25th anniversary of UT Health Science Center at Houston School of Nursing Dean Patricia L. Starck, D.S.N., R.N., F.A.A.N.
Noting at the outset that health care in the U.S. is organized around disease rather than prevention, Shine presented the main issues that affect access, quality and cost of care. A cardiologist who also has practiced in England, Shine offered a comparison of what we get for our efforts-and money-compared to five other industrialized nations with comparable healthcare assets. We get less and pay more, he observed.
He also discussed the paradoxes that characterize health care and our relationship to it in the U.S. One example: statistics show that 75 to 85 percent of us think the healthcare system-Shine calls it a "non-system"-is broken. However, 71 to 80 percent say they are satisfied with current care. And while there is public awareness of the importance of insurance, it is just one component of access to care. Transportation costs and the number of providers and their geographical distribution are among other factors that explain why so many of the poor are underserved.
Reviewing the situation in Texas, Shine noted that we have the highest uninsured rate in the country and a shortage in all categories of healthcare workers except for Licensed Vocational Nurses, the only area in which we are well above the national average rather than well below.
Looking at options to improve care and control costs, Shine stressed the critical role of electronic medical records in healthcare delivery and rewarding efficiency. He pointed out that U.T. campuses are being encouraged to "get ahead of the game" in healthcare bundling, offering a set price for a course of treatment. Also among his recommendations are working to reduce readmissions, pay-for-performance, coordinated care and a more rational approach to the evaluation of new drugs.
Shine sees an expanded role for nurses in the future, especially in integrative approaches to disease management and in health policy. He recommended that nurses weigh in, identifying where they fit into the picture and what their role is in any healthcare setting or issue. "Nurses are trusted," he observed.
He also touched on the role of culture in medicine, citing the case of angina. Canadians, it seems, are willing to live with chest pain. In the U.S., we opt for surgery. "We want things fixed!"
Shine has recently joined the Board of United Healthcare, the largest single health carrier in the U.S. A former president of the prestigious Institute of Medicine, he has been with the UT System since 2003 and is a frequent participant in discussions where critical health care options and directions are discussed and evaluated.
By Cynthia Johnson, Institutional Advancement