Value=quality/cost. A simple economic principal. Since the United States as a society spends nearly twice the amount of dollars on healthcare compared with its nearest competitor (Switzerland), several obvious questions arise, the most compelling of which is: Are we receiving quality commensurate with cost? Although “quality” in healthcare is a somewhat ephemeral metric, generally accepted international standards (infant mortality rate, life expectancy, etc.) do not even place the US amongst the top ten nations in the world in the healthcare received by its citizens. The problem is not trivial– the uninsured population is hovering around 15% and rising; healthcare expenditure constitutes an ever-rising portion of gross domestic product; the price of healthcare directly impacts not only families and individuals, but the price of labor and the ability of American industry to hire American labor and to compete in a global economy. And for all of this enormous and growing “cost”, payers and citizens rightfully would like to know what “value”, i.e. what “quality” they are receiving. In fact, the entire system of physician and possibly institutional reimbursement is being transformed from a “cost”-based one to a “quality” based one. In fact, such a transformation in physician reimbursement has already been instituted by the National Health Services of Great Britain. Demonstration projects have begun in the United States.
The impact of volunteerism on this paradigm is obvious: increased quality at marginal to no cost improves value. Recognition of this fact cannot realistically be expected to, in and of itself, transform the medical profession nor the entire nation into a willing army of healthcare volunteers. (Even if such a fantastic phenomenon were to occur, it is not exactly clear and, indeed, highly debatable what the most propitious use of such a willing “army would be!) However, this fact does not negate the importance nor the opportunity which volunteerism presents in improving the situation. In fact, volunteerism is somewhat rampant in the daily affairs of the medical profession. Physicians and other healthcare professionals volunteer their precious time to serve on essential hospital committees, professional societies and journal editorial boards. All healthcare workers, to varying degrees, care for the indigent. Emergency healthcare efforts in disastrous situations are legendarydespite the virtual collapse of all organized societal infrastructure in New Orleans during hurricane Katrina, the doctors, nurses and hospital workers heroically, even at risk to their very lives, cared for the sick under increasingly impossible circumstances, and saved very many lives. The truth is that volunteerism is not only an ameliorating factor, but may be the single most profound economic reality keeping the American medical profession afloat.
So what does a research institute have to do with volunteerism? The compelling fact is that heart disease remains the leading killer of men and women in America, in much of the Western world, and, within a generation, most likely in the entire world. Armed with this realization, for nearly a decade the Florida Heart Research Institute has performed free cardiovascular risk screenings for the medically underserved population of Miami Dade County. The collection of this data is a governmental imperative, and this in no small measure explains the involvement of the National Institutes of Health and the Centers for Disease Control in various aspects of cardiovascular risk screening of the population. Although screening alone is not sufficient for effective prevention, it is the essential first step. Through our efforts we have not only directly benefited many individuals, but have been able to raise the level of community awareness and community action. Return on investment? These efforts have established the Florida Heart Research Institute as a good faith broker of education and prevention in a very complex and vibrant South Florida community, they have formed the basis of future research and educational efforts, and they have helped to increase the “value” of healthcare in our community. Hopefully these efforts will serve as but one of countless examples to promote the vital role of volunteerism in the health care community.
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