Demanding Overhaul of U.S. Health Care
Only a massive overhaul in the nation’s health-care system will cut the enormous death toll from medical errors and improve quality of care for millions of Americans, a prominent think tank says in a report released today.
Too many people receive unnecessary, incompetent or inadequate treatment, the researchers say, and only fundamental changes in the way medicine is practiced can solve the problems. The report, from Santa Monica-based Rand, urges the development of standardized guidelines, similar to ones in the airline industry, that rely on extensive checklists and computer monitoring to ensure safety.
“No one has ever tried to look at this system in a coherent way and do the kind of improvement that is done in other industries,” says Dr. Robert H. Brook, a Rand vice president and director of its health program. “The great irony is that the newspapers have headlines about fuel tanks on jets exploding every five years. Yet we’ve got the equivalent of hundreds of these planes blowing up every year but nobody cares enough to do anything about it.”
The Rand paper, published in the public policy journal Health Affairs, echoes the findings of a report issued in March by the Institute of Medicine, a division of the National Academy of Sciences. That report charged there was a vast “chasm” between what health care is and what it could be if the available resources were used more wisely.
“We’re not getting much bang for our buck,” says Elizabeth A. McGlynn, one of the paper’s coauthors and director of the Center for Research on Quality in Health Care at Rand.
The hard-hitting Rand paper is part of a growing nationwide crusade to cut medical errors and improve quality of care. The report card for the nearly trillion-dollar health-care industry, which consumes $1 of every $7 spent in the United States, is pretty dismal, according to the Rand researchers, and the situation far more dire than most Americans imagine.
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Among the findings, which were culled from recent medical studies:
* Only half of the population receives needed preventive care.
* Just 60% of those with chronic illnesses such as diabetes or hypertension get the care they need.
* About 20% of the care given to people with chronic conditions is unnecessary and may even be harmful.
* Deaths are preventable for 25% of heart attack patients who die in the hospital each year.
* And 100,000 Americans or more die each year because of medical mistakes.
With the aging of the population, such problems will only get worse, the researchers said.
“Thousands of more lives will be needlessly lost if something isn’t done,” Brook said. “It’s not that doctors are evil or nurses incompetent. The system itself works against the delivery of quality.”
Several key areas need to be fixed, the report said, including the way doctors themselves do their jobs. In an era of high-tech medicine marked by dazzling advances in treatments, diagnostics and surgical techniques, doctors are still clinging to practices rooted in the 19th century. They rely on often illegible, messy, handwritten notes to track patients’ progress and are expected to remember appropriate approaches to treating a wide variety of disease, rather than referring to formal guidelines.
“It’s shocking how rudimentary the practice of medicine is,” McGlynn says. “Airline pilots have checklists. Why not in medicine? But physicians balk at practicing what they call ‘cookbook medicine.’ ”
Studies have consistently shown that implementing standard procedures yields a higher quality of care and better survival rates. Yet the Rand researchers found no national tracking system for ensuring that the best practices are used, or any method for pinpointing defects and correcting them before someone dies. And because there is no way to identify who is doing a good job, and who isn’t, there are no financial incentives to drive poor-quality hospitals, medical groups and doctors out of business.
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Part of the problem is that the health-care system is so fragmented. Getting different HMOs, insurance carriers, hospitals and medical groups to adopt uniform systems, especially when they’re competing with one another, is more difficult than herding cats.
“It might be easier for a plan with 5 million members to spend money on a new computer system that speaks to each other than it is for a doctor’s office with two pediatricians,” says Bobby Pena, a spokesperson for the California Assn. of Health Plans, an industry trade group.
What’s more, most health-care providers are financially squeezed. “It’s wonderful to talk about an ideal of delivering quality care,” says Dr. Marie G. Kuffner, a UCLA anesthesiology professor and a former president of the California Medical Assn. “But where are you going to get the money to pay for these new systems? And it’s an enormous challenge to get cooperation among all the entities in our helter-skelter system.”
Still, a patchwork of programs dedicated to improving quality does exist. For instance, the Leapfrog Group, a consortium of the nation’s major employers, such as GM and IBM, is calling upon hospitals to implement systems that would reduce errors, and reward centers of medical excellence. And last month, the Bush administration asked Congress to earmark $12 million in start-up money to devise a national database to collect medical mistakes with the intent of using this information to avert problems in the future.
But Brook says the U.S. needs to make quality care a national priority--on the order of its commitment to putting astronauts on the moon--to improve the situation.
“‘We have walks to cure cancer and AIDS,” he says. “But the central issue cutting across all of this is that these people are getting mediocre care. If we could mobilize all these forces, we could save many of them. Why can’t we make that happen?”
