Everyone debates how to improve the nation’s health while affording health care reform. As a registered nurse for the past 31 years, I’ve seen dramatic positive and negative changes in health care. That spectrum ranges from the vast educational resources now available, evidence based practice and technology to the high cost, shortage of providers and services and lifestyle changes. Health care reform is a continuum that will take time. Long term solutions to health care reform include prevention, access and accountability which will provide the greatest benefit in the most cost effective model.

In my 20+ years of working in women’s health throughout central Wisconsin, at the state and national level, I became well versed in the fiscal effectiveness of prevention. As the Journal of HealthCare for the Poor and Underserved noted in 2008, for every $1 spent on publicly provided family planning services, $4.02 was saved in direct medical costs. Preventative measures of following cancer screening recommendations which lead to early detection, prevents costly treatment. Promoting comprehensive preventative exams for people of all ages, along with immunizations allows for early detection and treatment of identified conditions and prevents sequele from preventable illness.

There is proof that prevention works, but we need to be sure everyone knows and can access and utilize the appropriate resources in a timely manner to be most cost effective. With the shortage of primary care providers in Wisconsin, getting timely appointments for screenings and follow up care becomes a challenge. Mid-level providers and nurse navigators are cost effective means to connect patients with the level of care that is needed. Disease specific programs overseen by doctors with nurses, dieticians or educators meeting with patient have been successful for anti-coagulation management, diabetes, asthma and heart disease and save valuable resources while improving health outcomes. Access to health care resources by people of all ages, ethnic groups, geographic areas and economic levels is crucial. These resources range from educational materials suited to the various groups, access to screening programs, technology and providers and reducing barriers to that access. In my current position as Quality Director for a Critical Access Hospital, I hear from many families who lack the knowledge about how to navigate the health care system, where to find information related to their health-both preventative as well as disease specific and requests for financial assistance.

So where does accountability figure into health care reform? Our society has focused on the quick fix of prescriptions and placed our hopes on emerging technology to take care of our ailments. It is time for each of us to be accountable and work with the healthcare system on our individualized health plan. Patients need to be networked with the array of services and providers that are readily available and take the initiative to be proactive. Providers need to work across systems for the good of the patient. We’ve allowed the electronic medical record systems used at our hospital and clinics to share data with providers at neighboring referral centers. This sharing of records improves timeliness of care in emergent situations like stroke, traumas and heart attacks where the accepting facility can view the data and be ready when the patient arrives. This also reduces the cost of repeating tests. We need to share best practices among providers and patients and then make the effort to improve our health. Healthy diets, exercise and routine health care monitoring are effective measures to reduce health care costs and at the same time, dramatically improve our health.

We need to realize that prevention is a process versus a quick fix. As we incorporate prevention strategies, we will need to continue with the treatment of conditions. Over time, increased prevention strategies such as knowledge sharing, screening, maintaining good health by ongoing monitoring and access to services, along with improved patient involvement will decrease the need for treatment and the associated costs. The long term effect will be reduced treatment costs so that those allocated treatment funds can be utilized to increase access to preventive care programs. Knowledge is power, but we need to harness this knowledge and use it responsibly by be successful in health care reform.