There have been many changes in the health care landscape over the two decades since Harvard Medical School’s (HMS) Department of Health Care Policy was inaugurated, but much work remains to ensure equitable, effective health care for all.
That was the message of speakers at the 20th Anniversary Symposium of Harvard Medical School’s Department of Health Care Policy Tuesday (April 29) at the HMS New Research Building.
Department Chair and Ridley Watts Professor of Health Care Policy Barbara J. McNeil opened an afternoon of panels and speeches on the state of health care in America with a review of the department and its accomplishments since it was founded in 1988.
The department has grown dramatically over the years, McNeil said, expanding both its teaching and research activities. Today, the department has 27 faculty members and 11 affiliated faculty members, a large increase over its four founding faculty, who were McNeil, John H. Foster Professor of Health Policy and Management at the Harvard School of Public Health Arnold Epstein, Professor of Medical Sociology Paul Cleary, and John D. MacArthur Professor of Health Policy and Management Joseph Newhouse.
From its initial educational offering of one elective course and one postdoctoral fellow, it now offers a required HMS course and has 20 postdoctoral fellows. It has had 177 doctoral students over its two decades and runs a joint M.D./M.B.A. program with Harvard Business School.
The department’s research focus has become more systematic over time, McNeil said, from a hodge-podge of subjects being pursued by its founding faculty members to a focus on access to care, health care economics, quality of care, drugs, and social determinants of health.
The symposium featured three sessions focused on health care quality, health care cost, and mental health. The keynote address, delivered by Henry J. Aaron of the Brookings Institution, focused on health care cost control.
Several speakers early on in the day cited a lack of comprehensive information as a major hurdle in improving health care quality in the United States.
Sharon-Lise T. Normand, professor of health care policy at HMS and of biostatistics at the Harvard School of Public Health, said that with rapidly changing health technology and an aging population, the current system cannot produce enough information to adequately assess and improve health care quality.
“We simply cannot efficiently produce information under the current paradigm,” Normand said.
Paul D. Cleary, dean of the Yale University School of Public Health, went a step further, saying that a “medical industrial revolution” is needed to improve the quality of health care in the United States.
Cleary, who spoke on quality of care during the initial panel, said efforts to improve care have changed dramatically over the years, from a provider-centered focus that emphasized better training of individual doctors and nurses — complete with continuing medical education requirements and regular reading of advances in medical journals — to a system-centered approach today.
The problem, he said, is that the various approaches have been ineffective in improving the quality of care and in narrowing the consistent gap that remains between the wealthy and the poor, between whites and minorities, and between those with insurance and those without.
“Things have gotten better, no doubt about that, but improvements have been slower than anyone anticipated 20 years ago,” Cleary said. “Everyone agrees there’s a huge chasm between what is possible and what is not. … I think just about everyone is frustrated.”
Thomas H. Lee, chief executive officer of Partners HealthCare Inc. and network president of Partners HealthCare, said he was optimistic that progress will be made in the coming years. Research has moved ahead in recent decades, and today new thinking on how to improve health care quality makes a rapid transition from research to practice.
“The gap between the bench and the bedside in health services research has virtually disappeared,” Lee said.
Lee said there remain questions about the relationship between quality and price and whether consumers will be willing to pay more for higher-quality care.
“The challenges are daunting,” Lee said. “[But] I’m actually optimistic that we’ll do some good work and make some real progress.”