Thursday, May 21, 2009

Present state of American medicine

In my first entry I traced the history of medical care since WWII. I ended with a statement that we had arrived at a state of excessive use and errors and harm. Before we can proceed in our analysis of what and how the system went so wrong, we need to get more specific about what is wrong with American medicine.

So here is a list, in no order, of the problems. I am not documenting the sources but if challenged for accuracy, I believe I could dig up the sources.

First, let's look at our major strength. We are a rescue system. Get in a car wreck and your chances are best in the world to survive. Have a heart attack, and you will receive the best care in the world. Get a life threatening illness and American medicine will pull you through better than anyone.

Beyond these rescues from death, we are not very good. We are very expensive, we exclude almost 15% of our citizens from ordinary care, and we do a lot of harm in our hospitals. So here are some details.

We spend nearly 17% of our GDP
Our per capita expenditure is the highest in the civilized world.
We are the worst in what is called "amenable deaths" in the developed world (France is the best at preventing preventable deaths, we are the worst)
Our life expectancy is among the lowest in the developed world
We have one of the world's highest infant mortality rates in the developed world
Our prevalence of diabetes and obesity is one of the highest
We have around 100,000 preventable deaths per year in our hospitals.
In the last 6 months of life, we spend a large amount of Medicare dollars on futile care
(by futile care, I mean care that only extends the period of dying)
Our per capita expenses range from $4000 in one region to around $7500 in another region
The quality of care in Medicare is inverse to the dollars spent. It is best in the low expense regions and worst in the high expense regions.
The use of surgical procedures is highly variable from one small region to another, with no visible reason for the variation other than the capacity for the procedure.
Mortality rates for prodecures in hospitals are variable and range to unacceptable high levels in some.

American medicine is the only enterprise where competition has driven up costs and driven down quality.
The American public has no information on which to decide where to go for care.

Hospitals should be required to post their procedure and major disease mortality rates, their infection rates, complication rate, and the number of each procedure done annually. Until the public can have that information, it cannot make a rational choice of where they go for care.

If a can of food is required to carry a label of its contents, then something as potentially dangerous as a hospital should be required to post its contents and outcomes.

Medicare has the data on the hospitals it pays. They should publish the outcomes by hospital.

Internet Marketing

No comments:

Post a Comment