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19 How Will Health Care Professionals and Patients Work Together in 2020? A Manifesto for Change Ralph Hertwig, Heather Buchan, David A. Davis, Wolfgang Gaissmaier, Martin Härter, Kai Kolpatzik, France Légaré, Norbert Schmacke, and Holger Wormer Abstract How can we accelerate the shift to a new paradigm of patient-centered health care? In this report, a manifesto for change is put forth, while acknowledging that health care systems are highly complex systems for which there is no simple solution. The starting premise is that one needs to launch and reinforce positive developments among both clinicians and patients. To this end, a vision is offered to transform medical schools into health professional schools; specific ways of leveling the knowledge playing field between clinicians and patients are described to empower patients to ask more questions and dissuade clinicians from “avoidable ignorance.” The Wennberg three-step action plan is proposed to demonstrate how a patient-centered health care paradigm can work for important process and outcome measures. To foster patients’ engagement within the health care system, an existing model that teaches health literacy to children in primary schools is described and possibilities are proposed to foster the delivery of quality health care information via the media and online communities, with the Internet being the technology that is most likely to complete the change in the dynamic of doctor –patient interaction. The 21st century is viewed as the century during which reform ushers in an adult conversation between patients and doctors. Introduction Immediately after the election of Barack Obama and in the midst of the worst economic recession since the Great Depression, the President Elect’s newly 318 R. Hertwig et al. designated chief of staff, Rahm Emanuel, pronounced what has since become known as the Emanuel Principle: “Rule one: Never allow a crisis to go to waste. They are opportunities to do big things” (Zeleny 2008). Stigler’s (1983) law of eponymy has it that a great idea is never named after the person who had it first. Corroborating this law, Emanuel’s observation echoed the advice of Niccolo Machiavelli in Il Principe: “Never waste the opportunities offered by a good crisis” (Machiavelli 1513). We are indeed in the middle of a good crisis. Except in a few countries, health care systems in the industrialized world suffer from rising costs which, if not radically reformed, could soon bankrupt governments. The most glaring example is the system in the United States. Over the past few decades, U.S. health care costs have risen at a consistent 2.5 percentage points above the growth rate of the economy. If this trajectory were to continue until 2050, it is reckoned that Medicare and Medicaid (the government programs that insure the elderly and the poor, respectively) would together consume 20% of America’s GDP, almost as much as today’s entire federal budget (Economist 2009). Moreover, many experts expect that the health care reform that was finally passed in March 2010 will not reign in the drivers of America’s roaring health care costs (Economist 2010) and, according to a RAND analysis (based on the U.S. Senate version of the bill), will further increase America’s overall health care spending, relative to status quo projection (Ringel et al. 2010). America, of course, is not alone in this pickle. According to the Organisation for Economic Co-operation and Development (OECD), health expenditures grew rapidly in many countries between 2000 and 2003, with an annual average OECD growth rate of 6.2% over that period. In 2008, the highest health expenditures as a share of GDP were found in the United States (16.0%), followed by France (11.2%), Switzerland (10.7%), and Austria and Germany (10.5%). Health care costs have simply spiraled out of control. As Muir Gray expressed at the start of this Forum: “The last 40 years have been fantastic” for public health, with ever-increasing resources, the development of sophisticated research methodologies and treatment procedures, and the build-up of modern infrastructure. The once-full coffers are emptying, however, and we are entering a new period of scarce resources precisely as economic demands on the health care system are increasing. These demands include, for example, expenditures on long-term care for an aging population and on the consequences of climate change, which is expected to worsen virtually every health problem known, from heart disease and heatstroke to salmonella and insect-borne infectious diseases (Brahic 2009). Financial necessity, however, is not...

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