The American Health Care System Is in Pieces -- But Some of the Pieces Are Doing Remarkably Well

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from HuffPost:




Joe Satran
The American Health Care System Is in Pieces -- But Some of the Pieces Are Doing Remarkably Well
Posted August 5, 2008 | 06:17 PM (EST)



The American health care system is broken. Despite the world's most advanced medical technology and the heroic efforts of devoted clinicians, health care is too expensive, unjustly inaccessible and seriously harmful to many of the citizens it seeks to serve. Politicians and purchasers are exasperated, practitioners are beleaguered, and patients and families are rightly dismayed.

And just when it seemed like the news couldn't get worse, the Commonwealth Fund's 2008 National Scorecard on US Health System Performance, released this week, finds that across a broad spectrum of measures the country has not only failed to improve but the U.S. has lost ground compared to other countries. The litany of bad news must always start with the completely unacceptable fact that 40% of Americans are uninsured or underinsured, but other news is just as alarming:

· The US spends more per capita on health care than any other industrialized nation, but its overall performance rating (an index that accounts for systems' quality, efficiency, access, equity and the public's health) is just 65 out of 100.

· The US ranks last in the industrialized world on rates of "mortality amenable to health care" -- that is, the nation's care system often fails to manage those conditions that we know how to prevent or treat ("amenable" conditions), resulting in premature death and suffering.

· Minorities, low-income and uninsured adults and children are much more likely than other Americans to experience delays, receive poor-quality care and suffer damaging health outcomes.

· Infant mortality rates in the US are double the rates in other comparable countries.

Variation is the report's dominant theme: the care that is delivered reliably in one state, city or facility is simply unavailable in the next. What is even more puzzling is that the quality of care in one place bears no relationship -- and sometimes even an inverse relationship -- to the amount of money that is spent per patient there. No matter where we examine the system -- studying waiting times or access, studying hospitals, office practices or nursing homes -- what we observe are stark differences in performance. The sources of these differences are controversial, but while debates rage, patients suffer and fragmentation persists.

Ironically, this fragmentation has revealed some paths to genuine improvement. The parts of the US health care system that perform well don't just exceed their peers by small increments; they do so by miles. Studying these exceptional states, cities and facilities might be the key to meaningful progress. Some ideal subjects for study include:

· States like Massachusetts, which has provided health insurance to more than one million new individuals in the last year; Michigan, where a project to reduce hospital infections saved more than 1,500 lives and avoided more than $160 million in costs; and New Jersey, where 150 health care organizations reduced the incidence of bed sores by more than 70%. .......(more)

The complete piece is at: http://www.huffingtonpost.com/joe-satran/the-american-health-care_b_117138.html