There is a reason the rich and famous from around the globe travel to the United States when they need critical care. They come here because we have the best doctors, nurses, researchers and hospitals in the world. Bar none.
But there is a dangerous divide between the high-quality, world-class care our health care system is capable of delivering and the uneven quality that it delivers day in and day out for ordinary Americans. Too many people don't get the care they need when they need it, and that includes the people who have health insurance. Even worse, we too often harm and sometimes even kill those who seek care.
As physicians, no one knows better than we do about the valor and talent of the people on the front lines of health care. They all want to do right by their patients. But these good people are hampered by a bad system -- a non-system really -- that badly needs to change.
The good news is that change is coming. Better yet, in some places, it has already arrived.
Across the United States, a genuine transformation has begun in health care. It's rooted in improved transparency. Increasingly, we can now see which doctors' practices and hospitals are delivering great, quality care, and those that need to improve, thanks to a new wave of public reports about their performance.
Moreover, health care providers are borrowing quality improvement techniques from the airlines, manufacturing and other industries that we count on to get it right every time. And then there is a quiet revolution taking place among patients and their families, who are learning how to make sure they and their loved ones are getting the best care for their conditions.
This month, the Robert Wood Johnson Foundation, the U.S. Department of Health and Human Services and dozens of national organizations will work together on Care About Your Care, an initiative to accelerate this transformation by informing patients and families about what they can do to identify and receive better health care.
The initiative will shine a bright light on the state of health care quality in the U.S. and, we hope, spark conversations about the steps Americans can take to improve their care. Throughout the effort and on CareAboutYourCare.org, patients can find information to help make the right choices for themselves and their families, establish a better relationship with their doctor, and start down the road to better care.
Why the effort?
When Americans go to the doctor, it's essentially a coin-toss chance whether they will get the care medical experts recommend for specific conditions. U.S. adults get 55 percent of recommended care and children get 47 percent. As many as 91,000 Americans die each year because they don't receive the care medical experts recommend for chronic conditions, such as high blood pressure, diabetes and heart disease. Too many people don't know basic facts such as smoking, poor diet, lack of physical inactivity, obesity and alcohol use can put them at risk for heart disease. And even with cutting-edge technological advances in treatment, we still make far too many mistakes. Preventable medical errors kill as many as 98,000 Americans each year -- the eighth most common cause of death in this country.
But there is hope, too. The movement towards transparency in health care means that people can get more information about their local physicians, clinics and hospitals than ever before. Patients can use this data to make the best choices for themselves and their families about where to get quality care. Doctors can use this data to identify areas for improvement.
There is mounting evidence that transparency works. In Minnesota, physicians were troubled by a statistic: 26 percent of all deaths in Minnesotans were due to heart disease and stroke. They also knew there are four things patients who are at risk can do: keep their blood pressure low; keep levels of "bad" cholesterol low; take an aspirin daily; and don't smoke. But now, thanks to reports published online by Minnesota Community Measurement, doctors can also see how well they are doing helping their patients meet these goals.
To improve its numbers, doctors at the White Bear Lake Clinic near St. Paul began an initiative to get patients to meet all four goals to help lower their heart disease and stroke risk. They kept a list of patients with heart or vascular disease who were not meeting the four goals. They worked with these patients to create an "action plan" to work toward the goals. They also hired a care manager to check with patients in between appointments, answer questions, work with them on individual action plans, and keep them motivated.
"We find that this personal touch really helps them stay on track to better health," said White Bear Clinic's Dr. Bruce Leppink. The results are promising: 70 percent of their at-risk patients met the goals.
Next door in the Badger State, the Wisconsin Collaborative for Healthcare Quality has seen significant improvement among the 567 practice sites that participate in its public reports. Knowing their scores are available has motivated physicians to improve care. According to a recent study, patients with diabetes who got care at participating practices were more likely to receive the recommended blood sugar, eye and lipids tests than patients in Wisconsin practices that do not participate in public reporting.
Five years ago a map of similar efforts at transformation across the country would have been pretty empty. That's changing. Today there are 16 communities, some of them entire states, participating in the Robert Wood Johnson Foundation's signature program to improve quality, Aligning Forces for Quality; 17 communities in the U.S. Department of Health and Human Services' Beacon Community Cooperative Agreement Program, working to develop systems of electronic health records; and 24 communities in the Agency for Healthcare Research and Quality's Learning Network for Chartered Value Exchanges. In each of these communities, doctors, patients, hospitals, employers and others are working together to improve care, with a major focus on transparency. You can see a map of them here.
Patients can contribute to this movement by advocating for better health care for themselves and their families, and by telling friends how to find better health care, too. When patients go to a doctor, they should be ready with a list of questions and a record of all medications. And patients should take a friend or family member to appointments so they don't miss anything and, if possible, have one doctor or nurse coordinating all their care.
People with a chronic ailment such as heart disease or diabetes can learn about the best treatments and look for and use publicly available quality reports to find out which nearby providers do the best job of getting their patients the care they need. RWJF offers an easy-to-use map of available public reports.
Finally, they can ask their doctors if they use computerized medical records to keep track of their treatments and conditions, since this can reduce errors and unnecessary tests.
Find out more about the transformation taking place in health care and your role at Care About Your Care. Being educated about quality care and where to find it can not only save your life, but the life of someone you love as well.
Risa Lavizzo-Mourey, M.D., M.B.A., is the president and CEO of the Robert Wood Johnson Foundation, and Mehmet Oz, M.D., is a cardiothoracic surgeon at New York-Presbyterian Hospital and host of TV's syndicated The Dr. Oz Show.
David Gratzer: Canada's Biggest U.S. Import: Fat?
As long as health care is for profit, our system is doomed.
http://money.cnn.com/2010/08/11/news/companies/health_care_medical_travel/index.htm
One way to cut health care costs? Outsource surgeries - Aug. 11, 2010
"NEW YORK (CNNMoney.com) -- Tina Follett and her husband Patrick are in Panama on a two-week all-expenses paid trip. But Tina isn't on vacation. She's there to get surgery..."
Dental work is much cheaper in Mexico:
http://money.cnn.com/2010/07/07/smallbusiness/denticenter/index.htm
For cut-rate dental care, head to Mexico - Jul. 7, 2010
http://www.consumeraffairs.com/news04/2005/bankruptcy_study.html
Medical Bills Leading Cause of Bankruptcy, Harvard Study Finds
"...Today's health insurance policies -- with high deductibles, co-pays, and many exclusions -- offer little protection during a serious illness. Uncovered medical bills averaged $13,460 for those with private insurance at the start of their illness. People with cancer had average medical debts of $35,878.
"The paradox is that the costliest health system in the world performs so poorly. We waste one-third of every health care dollar on insurance bureaucracy and profits while two million people go bankrupt annually and we leave 45 million uninsured" said Dr. Quentin Young, national coordinator of Physicians for a National Health Program.
"With national health insurance ('Medicare for All'), we could provide comprehensive, lifelong coverage to all Americans for the same amount we are spending now and end the cruelty of ruining families financially when they get sick."
Medical disasters account for over 60% of personal bankruptcies.
as long as the healthcare industry is driven by profit there will not be any appreciable change. yes, transparency is good, but no health insurance executive should make millions on other peoples illness and sickness; no one should have to file bankruptcy due to medical costs (even with health insurance)...to me that's morally wrong.
http://www.huffingtonpost.com/2010/11/28/health-care-tax-break-deficit_n_788852.html
Job-Based Health Care Threatened
"WASHINGTON — Job-based health care benefits could wind up on the chopping block if President Barack Obama and congressional Republicans get serious about cutting the deficit.
Budget proposals from leaders in both parties have urged shrinking or eliminating tax breaks that help make employer health insurance the leading source of coverage in the nation and a middle-class mainstay.
The idea isn't to just raise revenue, economists say, but finally to turn Americans into frugal health care consumers by having them face the full costs of their medical decisions.
[snip]
Repealing the tax break would raise several hundred billion dollars a year, depending on how it's done. Many economists believe employers would boost pay if they didn't provide health care..."
Anyone who thinks employers would boost pay to compensate is delusional.
Don't know why the GOP did not pass tort reform under Bush when they also had the congress.
Great Sarcasm there.
There is a lesson here. I think our hospitals are getting too big and corporate - even the non-profits. It seems to me there should be an optimum size for a hospital - maybe fifty beds and a staff of a few hundred. And the big impersonal monstrosities should be forced to decentralize. There should, of course, be special facilities for conditions that require specialized care.
Reform is needed but our country is not ready to even discuss the issues - much less solve any problems.
But the next and most crucial step is for people to seek out and reward effective providers with their business
for that they will need health care dollars and portable insurance
force providers to compete on quality and cost
and watch health care costs come down
and no need for multi trillion dollar health care laws
http://reluctant-messenger.com/essene/gospel_of_peace.htm