Eliminating medical errors, assisting New Jersey residents in finding the lowest price for their prescriptions, and working for a better way to offer medical care for New Jersey’s uninsured and under-insured population are some of the issues on which the New Jersey Health Care Quality Institute is working. Its goal, says its president and CEO, David Knowlton, is to improve health care for everyone in the state.

Knowlton speaks to the Princeton Chamber of Commerce on Thursday, July 12, at 11:30 a.m. at the Marriott Princeton Hotel and Conference Center. Cost: $45. To register call 609-924-1776.

David Knowlton has been involved in consulting on health care issues since the mid-1970s. In April he testified before the United States House of Representatives’ Energy and Commerce Subcommittee on Health as part of the subcommittee’s examination of the nation’s uninsured population.

Prior to joining the Health Care Quality Institute (www.njhcqi.org), which was formed 10 years ago and is based in Trenton, Knowlton was principal in Knowlton and Associates, a consulting group specializing in health care policy issues. He also founded and served as executive director of the Health Care Payers Coalition of New Jersey, a non-profit corporation representing business and labor organizations which provide healthcare. He is currently a member of the Coalition’s board and executive committee. Knowlton has been interested in health, he says, since he was in college. He has earned graduate and undergraduate degrees in education and psychology from the University of Massachusetts and Trinity College.

The Health Care Quality Institute is currently focusing on several issues.

Prescription price shopping. The Health Care Quality Institute has been instrumental in passing a statute that will establish a searchable online registry of drug prices. Users will be able to type in their zip code, the name of the prescription, and the dosage, and will receive a list of pharmacies in the area and the price each charges for the medication.

While people whose insurance plans include prescription coverage often pay the same for a medication no matter which pharmacy they use, those without the coverage can save a lot of money by shopping around, says Knowlton.

Prescription prices vary widely from store to store, and are usually based on the price the store pays to a wholesaler. The website will include the prices of the 150 most often prescribed drugs at every pharmacy in the state.

Hospital report cards. The Institute is also working to provide the public with more and better information on hospitals and doctors. The hospital report cards would use objective information to rate hospitals, nursing homes, and doctors.

The Institute is also working to develop better records for hospital-acquired infections. By studying when and where outbreaks occur, hospitals will be better able to control the problem, says Knowlton. Making these type of records more accessible to the public is healthy, he adds. “It’s like a fungus. You put it in the sunshine and it gets better.”

Healthcare reform. New Jersey’s current system of charity care is woefully inadequate and forces the 1.3 million residents who are uninsured to wait until they have a medical crisis. At that point there is little choice but to go to an emergency room. Unfortunately, this is “the worst level of care that can be provided,” says Knowlton.

He gives this example. “A person goes to the emergency room because he is having an asthma attack. Once there, he can be treated with a nebulizer, a device used to administer medication in the form of a liquid mist to the air passages. However, the emergency room cannot give the person a prescription inhaler to take home.”

Yes, the ER could write a prescription for an inhaler. But if the person has no insurance, he is unlikely to have the funds to purchase it.

The current system becomes a vicious cycle. Without access to continuing medication, the person is likely to have another asthma attack and again need emergency room care. In the long run this is an expensive way to provide health care. When you factor the cost of emergency room care versus the cost of a prescription and include the time lost at work, paying only for emergency care makes little financial sense.

The New Jersey Health Care Quality Institute is working with State Senate Health Committee chairman, Joseph Vitale, on health care reform proposals for the state.

In 2006 a new proposal to provide fundamental changes to the system was announced. The proposal will redirect money that is currently earmarked for “charity care” to provide insurance for anyone in the state who is not insured.

Essentially, Knowlton says, the state will require that everyone have health insurance, “just as we now require everyone to have auto insurance.” To track down the uninsured, New Jersey residents will be required to provide proof of health insurance when they pay their New Jersey taxes. If they do not provide the proof, they will automatically be enrolled in the state program and billed based on their ability to pay. If a person does not pay taxes, he will be enrolled in the plan if he presents himself at a hospital for care.

The problem, says Knowlton, is the transition period, when both systems will be in place. “We are working with the governor to come up with the money,” says Knowlton. Another controversy is the fact that under the plan illegal residents will also receive health insurance.

While some people don’t think that undocumented people have a right to medical care, Knowlton has a different view. “Yes, it looks like the state is paying for insurance for illegals, but hospitals are legally required to provide care for anyone who comes to them. I see it as reimbursing hospitals for the care they are required to give.”

Knowlton hopes the reform bill will be passed before the end of the year. “The governor is in favor of it and we have a senate and assembly that are the same party as the governor,” he points out. “I think the planets are aligned.”

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