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Policy, insurance, and creating a public health model

September 28, 2012
by Shannon Brys, Associate Editor
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Why is using a public health model important?  Thomas Simpatico, MD, Director of the Behavioral Health Institute at UVM Center for Clinical and Translational Science and also Director of the Division of Public Psychiatry at UVM College of Medicine, sought out to answer that question today. 

A public health model, as Simpatico described, is “anticipating the effects of actions that we take and doing that at the level of the population.”  He went on to say, “It’s understanding what works and making that public policy.”

Later in the discussion, Simpatico talked about the fact that the people with substance abuse issues touch many different parts of the system, including emergency rooms, clinics, courtrooms, jails, prisons, etc.

He said that if there are no coordinated action plans to help these people, “it’s not going to work for them.”  He continued with this thought by saying, “unlike DNA that can self-assemble, the healthcare system is not able to do that.”

Simpatico touched on the “Three Eras of American Public Health” in this discussion and presented them in this way:

1.      Prior to 1850:

a.      Epidemics

b.      Avoidance

c.      Acceptance

2.      1850-1949

a.      “Sanitary reform” through state and local health departments.  He used two examples to illustrate this era: indoor plumbing became common and doctors washed before surgery instead of only washing up afterwards.

3.      1950-present

a.      Gaps in healthcare service delivery systems

b.      Some populations more affected than others

After addressing these eras, he went on to say that he believes there are “giant gaps in the healthcare system.”

In order to create public health as a system, he said it is important to “use current knowledge for maximum impact,” be able to understand politics, and also able to motivate people with status quo. 

Simpatico spoke today at the National Conference of Addiction Disorders (NCAD) in Orlando, Fla. in a presentation titled “New Tools for Recovery and Wellness: Innovations in the Addiction Field Today.”  Also speaking in that presentation was David E. Smith, MD, FASAM, FAACT, Diplomate, American Board of Addiction Medicine. 

Smith also touched on public policy and showed his concern for the current insurance system saying that “the current health insurance system, as it relates to addiction, has been designed to exclude the sickest of people.”  He said that the insurance companies may say it costs too much to include these people in the system but this population goes to the emergency rooms which he says is “the most expensive and inefficient form of healthcare.”

Along the lines of being more efficient, he said, “You don’t want to give the most severe forms of treatment to the populations who may not need it.”  Here he was talking about “treatment matching” and described this phrase as “making sure that the people who need more intensive forms of treatment are getting it and making sure that you don’t have overtreatment of people who don’t need it."

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