How to repair trust in health care

The ideas and innovators shaping health care

Sep 27, 2022 View in browser   By Ben Leonard, Carmen Paun and Ruth Reader The pandemic may not be to blame for Americans' lack of faith in medicine. Confidence in the medical health system fell hard this year: In 2022, only 38 percent of Americans said they trusted the system, down from 44 percent in 2021, according to pollster Gallup . That would seem to confirm the conventional wisdom that U.S. health care took a big hit during the Covid-19 pandemic. But more than two decades of Gallup data show that trust in health care spiked at the pandemic's outset and has now returned to the modern norm's low levels. That's not good. The problem is intractable, and the solutions are hard to envision. But we'll give it a shot. NUMBERS GAME Faith in the health care system spiked in 2020, rising nearly 10 percentage points higher than it was in any year since 2001 in Gallup's survey as Americans rallied behind medical workers fighting Covid-19. The return to the recent normal – and low – levels of trust may be less a Covid story and more a reflection of a broader crumbling of confidence in American institutions that includes the media, organized religion and the government. What can we do about it?  There are no easy fixes, but some things can be done to restore trust, numerous experts we spoke to said. Here are four of their suggestions: Prioritize improved care for groups experiencing disparate outcomes and establish a dedicated leadership team. Deepening engagement in the community can also help build trust. Help ease financial anxiety by expanding health insurance coverage while increasing price transparency. Digital health technology can provide more touch points for providers to build lasting relationships with patients.  Reforming the for-profit health care model could help remove one reason people suspect providers have an ulterior motive. Mandy Cohen, North Carolina's top health official during the Covid-19 pandemic, emphasized using trusted messengers. "We partnered with many different folks in all walks of life, everything from Richard Petty in NASCAR to Rev. William Barber in the African American faith community," Cohen said. "We thought about simplifying the message but also who was delivering that message." Ideas are aplenty, but implementation is another matter. We'll keep our eye on Gallup's poll to see what the future holds. WELCOME TO FUTURE PULSE This is where we explore the ideas and innovators shaping health care, and where Carmen, whose hair decided to go gray early, hopes the gray-hair-don't-care trend is here to stay. Share news, tips and feedback with Ben at bleonard@politico.com, Ruth at rreader@politico.com or Carmen at cpaun@politico.com.  Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. TECH MAZE HHS wants doctors to shift to electronic medical records that are more easily shared, but logistical challenges have slowed progress. Why your new doctor may not know your medical history: Seamless access to and sharing of medical records promises huge benefits for patients when they switch doctors or see specialists. But delays in making it mandatory, despite a congressional directive, underscore that it's not imminent. The case for it is clear: Patients will gain if they can shop around and know their records will follow them. There's also less chance a new doctor will make a mistake if they know a patient's history. Congress saw the benefits when it mandated data sharing in a 2016 law, the 21st Century Cures Act. But nearly six years later, a provision barring providers from hoarding patient records isn't fully rolled out and advocates for doctors and hospitals are lobbying for a further delay. Why so slow? HHS finalized the information sharing rule on March 9, 2020, just as the world was shutting down to fight Covid-19. It delayed implementation during the pandemic, but the deadline is coming in nine days. The American Medical Association, the American Hospital Association and other medical industry groups wrote that they want another year in a letter to HHS Secretary Xavier Becerra and National Coordinator for Health IT Micky Tripathi yesterday. The organizations cited technical challenges. Vendors, they explained, are behind providers because HHS set deadlines that didn't align for them. Tripathi cast doubt on any delay in a statement to Future Pulse: "We don't believe patients or providers can afford to wait any longer." WORLD VIEW "It shouldn't be a pandemic fund because by the time it reaches a pandemic, it means we have failed." -- Ahmed Ogwell Ouma BEYOND PANDEMICS IN AFRICA — The recently established World Bank pandemic preparedness fund aims to help low- and middle-income countries — many in Africa — respond to major health crises. Ahmed Ogwell Ouma, the acting director of the Africa Centres for Disease Control and Prevention, said the goal should be to head them off before they become crises. Africa needs help building institutions at the ground level to improve health care and respond quickly to disease outbreaks, Ogwell Ouma said. The focus of the rich world on Covid-19, and the donations it sent to Africa to fight the virus, struck many African public health experts as too prescriptive. They would have preferred more flexibility to use the funding to combat long-standing plagues like HIV. The UN recently reported that the 1.5 million new HIV infections worldwide last year, a million more than the global goal, was a major setback in the effort to end AIDS by 2030. A measles outbreak in Zimbabwe, driven by a drop in immunizations during the Covid pandemic, has killed more than 700 children. And Ebola is spreading in Uganda. A different strategy: To build the institutions he envisions, Ogwell Ouma argues that African governments need to train experts, not only in public health, but also in legal and social issues. And he would also like to see African governments and businesses expand their own efforts to improve pandemic preparedness and response. "We need to ensure that we start domestically before you go out," he said. When governments set priorities at home, it's easy to channel international funds to those instead of being imposed by donors based on their interests, he said.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun   Follow us

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