Now Reading: The Story of Dr. Sidney Garfield: The Visionary Who Turned Sick Care into Health Care
I’m always inspired by doctors who think that there’s got to be a better way to both deliver and pay for healthcare. This book is a great find:
via Ted Eytan, MD:
Part of my eagerness is the fact that I didn’t enter medicine with the intention of being a Permanente physician; I didn’t even know what that meant, until the end of my residency, when the Group Health medical group in Seattle became the Group Health Permanente Medical Group.
All I knew at that time was that I enjoyed an approach to medicine that provided patients exactly what was needed – no more, no less, to maximize benefit and minimize side effects. This was and is a simple enough formula in my head – where did it come from? Is it better? If it is how should it be spread?
Sidney Garfield’s “a ha” is described in the book as a simple change to his payment scheme as a physician – when he could not afford to keep a 12-bed hospital in the Mojave Desert open on worker injuries alone, he accepted an arrangement with the insurer of the Colorado River Aqueduct project. The arrangement was a nickel a day per worker prepayment for injury treatment (to abate high costs from transporting injured workers to Los Angeles for care), followed by the addition of a nickel a day per worker for comprehensive care. The rest is history. An innovative physician discovered that he could increase his revenue stream by discovering the causes of injury in the workplace and preventing them before the patient was injured.
In short, Garfield reversed the traditional economics of medicine, in which physicians are paid only when a patient is ill. Instead, Garfield would benefit by keeping his patients healthy and accident-free. It was a lesson he would remind himself of in later years with a newspaper clipping he kept in his desk drawer describing the tradition in ancient China, where a physician was paid only while his patient was healthy, not while his patient was ill.
Garfield also recognized an acute change in the transition from training in academic medical center – from collaboration across specialties to the solo practice model, and sought to replicate this in private practice:
“It has always seemed a paradox,” said Dr. Garfield in later life, “that in universities, which teach us medicine, we learn medicine under the highest type of group practice, but when we go out into practice, we revert to the old type of individual private practice.” Dr. Garfield’s great contribution to the evolution of group practice was to layer onto it the additional power of two other elements: prepayment and integration of the medical group with what he termed “adequate facilities” — “bringing the doctors’ offices, laboratory, X-ray, and hospital … all together under one roof.”
