Clifton Studying Hands-On Health Policy Formation

Save Our ERs founder receives fellowship to go to Washington to address
health care system problems

Guy Clifton, M.D., a neurosurgeon at The University of Texas Medical School at Houston, has worked tirelessly to address the emergency room crisis that daily affects the Greater Houston area.

Guy Clifton, M.D.

Now, Dr. Clifton goes to Washington.

Clifton, professor and holder of the Nancy, Clive and Pierce Runnells Distinguished Chair in Neurosciences, has been awarded a prestigious Robert Wood Johnson Health Policy Fellowship that begins with a year in Washington, D.C., to study and learn how national health policy is developed.

Clifton is one of just seven health professionals nationwide chosen on a competitive basis for the 2006-07 fellowship. A three-month orientation in Washington is followed by a nine-month assignment in a Congressional office or in the executive branch. The program is administered by the Institute of Medicine of the National Academy of Sciences.

“It’s highly structured and with my objectives, made to order,” said Clifton, one of the founders of Save Our ERs, a coalition formed five years ago to raise awareness of Houston’s overextended trauma centers and emergency rooms.

His objectives include addressing a health care system that he believes is broken, and skyrocketing health care costs.

“I began to see a system implosion,” Clifton said. “Houston is a laboratory for health care failure. If you’re insured, you get care. If not, you only receive emergency care. It’s beginning to affect the ability of hospitals to function.”

Clifton believes that with a 31 percent uninsured rate in the Greater Houston area, emergency rooms and the Harris County Hospital District clinics will continue to be overwhelmed. He sees a similar situation in cities such as Los Angeles.

“ If you could control the costs, then Americans could buy insurance like they buy a car, with full information and accurate valuation.”

The uninsured problem is beyond the capabilities of states and regions and needs to be addressed on a federal level, he said.

“I’ll have the opportunity to see if there are possibilities in Washington,” he said. “I don’t think there’s a reason to deconstruct the private health care market. I think we can try to use the private market to take care of the uninsured.”

More and more insured are now becoming uninsured because they are priced out. Clifton pointed out that the cost of individual health insurance for a family of four is $12,000 a year, which is not affordable for many families. Health insurance, already too expensive for many small businesses, may have to be disconnected from employment, he said.

He also believes that coverage cannot be expanded until health care costs are controlled. Some areas of waste, which he estimates at 30 percent of services, include unnecessary end-of-life care, unnecessary surgeries, duplicated imaging and expensive medications given in lieu of less expensive ones.

“It’s a medical industry problem more than it is an insurance industry problem, and there is a lack of true market forces,” he said. “If you could control the costs, then Americans could buy insurance like they buy a car, with full information and accurate valuation.

“We need to establish how much an intervention is really worth,” he said. “For example, why do we pay the doctor that removes a skin cancer $1,500 but only pay the doctor who detects it $50? We have a pricing system unrelated to the value of the service. We have underpriced prevention and overpriced many unevaluated procedures and medications, with the result of un-managed care and unlimited spending.” For example, Clifton said, no one has looked at a surgical treatment such as fusion of the spine to ascertain the best candidate for the surgery.

Technology also has played a role in uncontrolled costs, he said. “The system worked when we didn’t have as much technology. But we have been so successful at creating new technology that much of it is un-evaluated and so is indiscriminately priced. We need a system where we can assign value,” he explained.

According to the foundation, after spending a year in Washington, the Robert Wood Johnson Health Policy fellows will return to their home institutions or practices and continue to work on improving health policy and management.

“The fellows bring much needed practical knowledge of the heath care system to Washington, D.C., where they can help our nation’s leaders to improve care,” said Michael Painter, J.D., M.D., the senior program officer and a 2003-04 fellow. “The ‘handson’ health care experience they bring helps them have a substantial impact on the nation’s heath care policy.”

Clifton is the second member of the UT Medical School faculty to receive the fellowship. Michele Curtis, M.D., associate professor of obstetrics and gynecology, was a 2002-03 fellow.

By Deborah Mann Lake, Institutional Advancement