Dr. Ricardo Martinez
Administrator, National Highway Traffic Safety Administration
From Spring 1996Volume III, Number 1
Dr. Ricardo MartinezBuilding Bridges was fortunate enough to be granted interviews with Dr. Ricardo Martinez, Administrator, National Highway Traffic Safety Administration (NHTSA), and Dr. Mark Rosenberg, Director, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC). These excerpts touch on the implications of managed care for traffic safety and injury prevention.
Managed care provides a huge opportunity for traffic safety. But injury prevention is not yet on the radar screens of many managed care organizations. Many managed care providers still hold the traditional view that injuries are not predictable or preventable. We need to change that mindset.
Compare the way that managed care organizations typically respond to cardiac patients and the way they respond to patients with injuries. When a person comes into a health care provider with chest pains, they treat the episode. But they also talk to the patient about reducing risk factors by losing weight, exercising, avoiding fatty foods, and not smoking. With an injured patient they just treat the injury and give the patient instructions on how to take care of the wound. We need to help them understand that injury is a disease process and can be prevented through risk reduction. We need to help them make the paradigm shift from treating injuries to preventing injuries.
One of the goals of managed care is to decrease utilization of treatment services and hold down health care costs. A healthy person requires little care and no treatment. But healthy people can be injured. The money that is spent on an injured person who requires long-term medical treatment and rehabilitation goes up and stays up. And a patient with a long-term medical condition caused by an injury is not going to transfer to another health care provider. An organization that can prevent injuries to its healthy patients can reduce its costs.
The evolution of managed care bodes well for this paradigm shift. Currently, people switch managed care providers every five to seven years. There is little economic incentive in spending money to educate people about injury prevention if you only have responsibility for them for a short period of time. But as managed care organizations merge and their market share increases, there are economic incentives to move to population-based injury prevention strategies, since each company will be responsible for a larger proportion of the population in the geographic area it serves. Providers will want to build alliances with people who have experience with such strategies. And these are the people in traffic safety and public health.
NHTSA has begun to build these alliances. We are working with the Group Health Association of America [a national membership association of health maintenance organizations]. Safe Communities [article on page 6] provides an opportunity for working with health care providers, public health agencies, emergency medical services, businesses, and traffic safety groups. We sometimes focus so hard on "motorcycle helmets" or "bicycle helmets" or "violence" that we end up competing with ourselves. The real issue is not motorcycle helmets or bicycle helmets or violence. The real issue is injury prevention. This is why Safe Communities views motor vehicle injuries in the context of the overall injury problem.
Another way that we can help managed care organizations make the shift to injury prevention is by creating data systems that will help them target and evaluate their efforts. NHTSA is working very closely with the CDC to develop these systems. We are working with the CDC on a uniform data set for emergency departments. We have a program called CADRE (Critical Automated Data Recording Elements) for law enforcement and traffic safety professionals. Our CODES program [featured in the winter 1995 Building Bridges] links traffic safety data with hospital and emergency medical service data so we can begin to look at both the causes and the consequences-including the financial consequences-of motor vehicle injuries. We found, for example, that medical care for a hospitalized driver who was involved in a collision and using seat belts was $5,000 less than for a driver who was not belted. That's a significant fact you can use when trying to get managed care organizations involved in prevention.
The transition to managed care is a long-term change which is going to occur with or without those of us who work in traffic safety and other injury prevention programs. We need to constantly look for opportunities to raise the issue and to bring people together. We have to make sure we have programs and resources to allow people to change roles. The opportunity is there. We should take advantage of it.
|
Building Bridges Home Page |
http://www.edc.org/HHD/csn/buildbridges/bb3.1/mancare.html
Revised: October 22, 1996
