Higher Education: Take a Lesson from Health Care

Higher education will look dramatically different in ten years. Where health care stands today offers lessons both good and bad in how to reform oneself.

Health care reform is one of the top priorities for new administration. But, talk to any current, recent or prospective college student or their parents about college costs and you'll realize that higher education isn't far behind in terms of its own crisis.

We work in both worlds and know first-hand that the two issues share common problems. Without a concerted effort they could share similar fates.

Consider this: As Obama made clear on December 11, 2008, despite an economy in recession and a six-year war being waged on two fronts, health care reform remains near the top of his national agenda. If health care reform legislation moves forward next year, which is a good bet, the government will decide what reform looks like, not the health care industry.

Higher education still has a chance to save itself. As Arne Duncan considers his new role as Education Secretary, those in leadership roles in the higher education community, including the presidents of colleges and universities and their trustees, must be willing to learn from the failures of the health care industry -- and voluntarily reform.

Costs for both education and health care are beyond the ability of many families to pay.

According to Measuring Up 2008, a recently released report, college costs have risen 439% from 1982 - 2006 - at a much faster clip than medical costs. At the same time traditional ways of paying for college are drying up -- credit for student loans is tight, home equity as a source of funding has disappeared, and state funding for higher education is falling by the wayside as they grapple with their own accelerating health care costs.

While medical care is (or should be) a necessity, postsecondary education was long seen as the privilege of a select few. This is no longer true in today's economy. With unemployment topping 6.5 percent, only the most educated will find new jobs quickly. In addition, two-thirds of all newly created jobs will require a college education or advanced training.

Higher education is not just a domestic issue. Our international economic competiveness is at stake as well. According to the Organization for Economic Cooperation and Development, among industrialized nations, the US has fallen to 10th place in the number of adults who have completed college. Our economy will never recover, much less grow, if we don't return to our former first in the world status.

If the post-secondary world wants to avoid government-mandated solutions to the fundamental challenges of access, cost and completion, colleges and universities should take their cues from several promising reforms gaining currency in the health care reform debate. While there are many examples to choose from there are three that college presidents and trustees can learn from: 1) patient-centered reform; 2) prevention; and 3) evidence-based decision-making. Let's look at how those three can be applied to higher education.

1) Patient-centered reform: Health care reform on Capitol Hill will focus on patient-centered solutions. For example, the National Quality Forum's National Priorities Partnership recently released a set of priorities that lead off with the creation of a patient centric health care model. As we have learned in this arena, major reforms don't succeed unless the end users are part of the solution. This is their leading priority:

Patients who are engaged as active partners in their health care... are vital to achieving better health outcomes, lower service utilization and lower costs.

In contrast, higher education policy still tends to focus on what is best for institutions, not the students. With a few tweaks, the National Quality Forum's language could easily be adopted by the education world:

STUDENTS who are engaged as active partners in their POSTSECONDARY EDUCATION ... are vital to achieving better POSTSECONDARY EDUCATION outcomes, lower service utilization and lower costs.

Higher Education should put consumers - the student - at the heart of the debate.

2) Prevention: Another focus area for health care legislation will be prevention. Reformers
have long recognized that spending a small amount up front to prevent illness has the potential to save billions of dollars on the back end. According to an article in the New England Journal of Medicine:

Preventable causes of death, such as tobacco smoking, poor diet and physical inactivity, and misuse of alcohol have been estimated to be responsible for 900,000 deaths annually -- nearly 40% of total yearly mortality in the United States.

In the same way, more students will succeed at a lower cost if we do a better job of preparing them for the work they will be doing in college. ACT found that only 25 percent of the 1.3 million American students who took their college placement exam in 2007 were ready for entry-level college courses in english, mathematics, social science, and natural science.

According to National Center for Education Statistics data released by Strong American Schools, "remediation in public institutions costs roughly $2.5 billion every year to provide students with the content and skills that high schools failed to provide them." As a nation, we are paying twice and wasting billions of dollars for the education that students should be receiving in high school.

The higher education community must work closely with the K-12 community to better align expectations and required skills for high school graduates.

3) Evidence-based decisions: During the presidential campaign, both sides embraced the notion of comparative effectiveness - choosing health interventions and life saving drugs, not because we think they will work, but because we know they will work based on the evidence.

Used appropriately, comparative effectiveness could result in policies that will improve health care quality and ultimately value by providing patients, physicians, and other health care providers with sound data upon which to base decisions.

The post-secondary education system in this country does a poor job of collecting and using data to make evidence-based decisions. Even worse, parents and students have severely limited access to information that will help them make good decisions about which college or university might be best. As the Secretary of Education's Commission on the Future of Higher Education noted, there is "a lack of clear, reliable information about the cost and quality of postsecondary institutions, along with a remarkable absence of accountability mechanisms to ensure that colleges succeed in educating students."

Policy makers, higher education administrators, and consumers alike must be able to make informed decisions based on evidence.

States should ramp up their efforts to build data systems that track outcomes for students at all levels and work to ensure that this data can be compared across institutions and states.

The postsecondary education system still has the opportunity to voluntarily make changes that will: Put the needs of students first, cost less, and help fix our economic woes. But if they wait too long, the government will step in.

Higher Ed - take a lesson from health care.

Comments

[CSHAL]

We're the Center for Student Health and Life www.cshal.orgg), focusing upon improving the health of college students. So we're right at the intersection of health and higher ed, the focus of the article.

BOTH health costs and higher education costs are spiralling out of control. For health care, the increase has been about 10% a year for a while. For higher ed, the increases in tuition and fees have also outpaced inflation. And now, due to tightening state budgets, students and families are being asked to pay more tuition and face higher fees to cover the shortfalls. All this at a time when family 529 and 401k plans have been decimated!

We believe more creative ways must be found to keep costs in check while preserving a high quality of health and wellness services on college campuses. One example: many schools make it very difficult for a family's current health insurance policy to be used when visiting the health center, and require families to "double pay" in the form of additional insurance or costs for services. Why don't they just accept a family's current health insurance policy? The reasons have to do with cultural obstacles (campus physicians often don't want to have to do "coding," for example) and reluctance to deal with additional paperwork (there are ways to deal with this as well).

Universities need to explore common-sense solutions to keeping costs in check -- and not place heavier and heavier financial burdens on the backs of families!

[Mnemanth]

"Where health care stands today offers lessons both good and bad in how to reform oneself."
What planet are you on? Show me the good in current health care policy!
We better get to getting our up and coming stars educated. As it is we've got a generation of x-boxers who're going to be running our businesses, and our country. Ever seen "Idiocracy"? We're on the road to ruin.
College should be mandatory. Either that, or join the military. But our young people need to get with it, and we need to provide them with something more than the college "education" we're providing now. It's all too easy to cruise through college in the U.S. with nothing more to show for it but a history of hang overs, a meaningless piece of paper, and years of incoming debt.

[mlaiuppa]

All well and good. But you have to be careful of education going the way of HMOs. You don't want the quality of education to suffer for the sake of saving a buck. You also have to be careful of the "one size fits all" assembly line etc. educational methods also instituted for the sake of saving a buck. The type of education the 21st century needs isn't the same as what was needed in the early 20th century. You're not producing assembly line workers with the minimum education just short of illiteracy. You can't expect to produce creative, outside the box, thinkers in a massive lecture hall.

Reform? You bet. It's needed very badly. But it's never gone far enough. Education needs to be reformed right down to it's funding base. Until you chance HOW education is funded, anything else you do will only be shallow and the effectiveness limited.

[ajupresident]

Execellent article - the third party payer problem is huge and Colleges may be the next group looking to the government for a bailout.....check out this article

http://www.webwire.com/ViewPressRel.asp?aId=82538

[treindl]

This is DEAD ON. Both higher education and health care are maturing industries that have been ruled by a guild mentality and are finally being forced to face the reality that the world is changing around them. Another important parallel is that public confidence in both enterprises is suffering. Remember the days when we did not question--or fight--doctors and hospitals? The day is drawing near when higher education's plea of "just give us more money" will be met with "show us the results." I hope that this recession will spark a vigorous and healthy debate about the role of the American people and their governnment in propping up industries that are slow or outright resistant to change.

[benne]

Higher education needs little reform. As for cost-saving, it could be easily achieved if the middle management added in the last 10 years, with all its offices and regulations, was simply cut. There's no crisis here besides the crisis of the rising bureaucracy and its costs.

[davism97]

I doubt cutting costs will solve the problem of preparing high school students for college level courses.

[Mack20]

And finally, I would like to address the taboo subject of textbooks. I would like to know who makes what on a $99 paperback textbook. I usually spent about a hundred dollars per term on 4-5 books. Outrageous then but highway robbery today. The average we spend today is never less than $500 per semester per child. With today’s technology, everything should be either on a disk or available on-line. Sorry professor, but we don’t need the brand new 5th edition of your published book. Any additions could be easily accessed on-line while the student spends a reasonable $25 on the used 2002 publication. Come on! Macro Economics has not changed that much in 6 years. This whole system is a real scam that should be investigated.

[Mack20]

No surprise there aren’t any takers at the HuffPost on this subject. Many of the posters here are educators.

As a parent of two college students, I appreciate your post. But I have a hard time with the comparison to our current health care situation. The public education system, both k-12 and beyond, is a typical government run entity. Spending has been out of control at all levels, increased taxation and tuition is the popular solution by our bureaucrats and administrators, while market forces are completely ignored. The value of a good education today has been dramatically lowered. My tuition costs in 1978 at our local state university was $150 per QUARTER. By the time I graduated with an MBA in 1984, the cost had risen to $500 per SEMESTER. Students loved the quarter system while educators preferred semesters. No shock that the needs of the professors outweighed the needs of the students. At any rate, today’s tuition at the same institution is over $4000 per semester. Has the value of my kid’s education increased 8 xs more than mine was 24 years ago. At that rate, a $9,000 car purchased then should sell for $72,000 today. $1.25 a gallon gas should be $10 now. And a $2.00 six pack of Bud back in “them days” should sell for around 16 bucks now. People should be screaming bloody murder about this.