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Customer‐Ownership in Equity‐Oriented Health Care
Author(s) -
EBY DOUGLAS K.
Publication year - 2018
Publication title -
the milbank quarterly
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 101
eISSN - 1468-0009
pISSN - 0887-378X
DOI - 10.1111/1468-0009.12350
Subject(s) - health care , equity (law) , general partnership , health equity , government (linguistics) , business , political science , geography , medicine , public relations , economic growth , finance , economics , law , linguistics , philosophy
T he research by Ford-Gilboe and colleagues 1 in this issue of The Milbank Quarterly demonstrates that equity-oriented approaches to health care can lead to improved health outcomes, and this has been our experience at Southcentral Foundation (SCF) in Alaska as well. A key component of our approach at SCF has been the community taking ownership of health care at both a system and a personal/family level, thereby leading the way in determining how services are provided. SCF is an Alaska Native–owned health care system responsible for providing health care and related services in partnership with approximately 65,000 Alaska Native and American Indian people in southern Alaska. Prior to 1998, health care for Alaska Native people was provided by the US government through the Indian Health Service (IHS). Even though the IHS staff were well intentioned, care was provided for Alaska Native people in the “usual” professional and institutional-centric medical approach. This resulted in little real understanding of the community, and services were less effective and did not address whole-person wellness. Most health outcomes were in the bottom 5th percentile for the United States. In 1998, when Alaska Native people took full ownership of their own health care in south central Alaska, a fundamental shift occurred. Health care was now being provided in partnership with Alaska Native people by Alaska Native people. The system was rebuilt from a customer-driven perspective reflecting the principles and values of the Alaska Native people. The result was the SCF Nuka System of Care, which has resulted in most health outcomes now being in the top 25th percentile while showing markedly reduced use of hospital beds, the emergency department, specialists, pharmaceuticals, and clinical testing. In addition, our partnership with the community has led to SCF twice receiving the Malcolm Baldrige National Quality Award, which is the United States’ highest presidential honor for performance excellence.