CHOICE KEY IN 21ST CENTURY OF MEDICINE

Quality, choices, true health care, these are the words health-care providers use to describe the 21st century.

"It will become advantageous for the physician to keep people healthy. It will be cheaper to keep them healthy," said Dr. Rod Crist, a family practitioner in Cape Girardeau. "As time goes by you're going to see physicians do more preventative stuff, more true health care."

That emphasis, Crist said, might mean putting pressure on patients to give up smoking, drinking or other activities that pose health risks, or physicians may refuse to treat them.

"It's going to be far more advantageous for the patient to be healthy," he said. So for the first time in U.S. history there's a huge push on for preventative health care versus what's been done previously -- disease care. In other words, patients go to the doctor when they are sick. Or they come to the doctor with their heart attack when 30 years ago the doctor should have started them on a diet and exercise program.

"Yeah, there will be a very big push for health care because it's cheaper," Crist said.

Mary Nowotny, director of corporate communications for United Health Care of the Midwest, said managed health-care providers will offer consumers more choices in future programs.

"We know that for those members who are at risk of congestive heart failure, we can provide the kinds of programs through the physicians that will really improve their health care and quality of life," Nowotny said.

Managed health-care systems have come under fire in recent years for being overly concerned with lowering costs and not providing quality services.

"Health-care premiums have not increased significantly over recent years where they had been increasing at double-digit percentage rates," Nowotny said. "As we have seen more membership in network-based health plans we've seen those costs come down.

"Now when we talk about that kind of quality what we talk about is improving health care."

Nowotny said United Health Care, which was born in October from a merger between GenCare Health Systems and Physicians Health Plan of Greater St. Louis, offers programs that concentrate on advanced research into neo-natal care and programs that allow consumers to see a specialist without a referral.

"We believe it comes down to a matter of choice," she said. "That's good for the employers too; it gives them a chance to shop as well as letting the members shop."

Nowotny said rapidly improving computer systems will begin to reduce the amount of administrative work physicians will do and the amount of paperwork consumers will see.

"There is such a wealth of good information out there," she said. "It's a matter of consumers' and employers' ability to process that information effectively that will really lead them to so many advantageous programs through the network-based systems because of the captive data that exists in these systems."

The nursing field will also experience changes that will open the way for more nurses in the future and provide for better outpatient care.

"Because of the short-term care in the hospitals more nurses are moving into community settings," said Dr. A. Louise Hart, chairwoman for Southeast Missouri State University's department of nursing. "When you move from an acute-care setting into a home-health care setting it takes additional skills."

Hart said those skills will require additional education and training for nurses as they prepare to handle more responsibility. She said with nurses becoming more involved in the normal routine of patients, the disease or injury causes can be reduced.

"What's wonderful about the move is in the home situation you see the patient basically in the environment they got sick in," Hart said. "You see that they have scatter rugs and they fell down and broke their hip. You see that the room is not aerated enough. You see that their nutrition isn't appropriate. So you have some wonderful opportunities for teaching, right there in the home situation."