Category Archives: Health Care Quality

Commonwealth Misses Again

For the last two decades, critics of our largely private health care system have published paper after paper comparing U.S. health care to health care in other countries. Most of them tell the same story: the U.S. health care system costs more than any other health care system and produces the same or inferior outcomes.

In almost every case, researchers treat the data used to reach their conclusions as perfectly sound. Unfortunately, the data used to compare national health systems are generally much less than perfectly comparable. Expenditure data are calculated using different accounting systems, vital statistics are logged using different definitions and coding customs, and prices are controlled and therefore uninformative, especially in government controlled health systems.

The latest example of using dodgy data to portray the U.S. health care system as a failure comes to us via yet another study funded by the Commonwealth Fund. The claim this time is that the U.S. health care system is bad because it allows more people to succumb to “amenable mortality,” deaths that could have been prevented with “timely and effective health care services,” than health systems controlled by national governments. While the paper is an interesting academic exercise, the quality of the data used to produce its results are simply not up to the task of saying anything useful about the relative quality of medical care in different countries.

Nevertheless, recent headlines trumpeted the finding that the United States health care system performs poorly, presenting the results as unassailable fact in stories that were warmed over versions the Commonwealth Fund press release.

Continue reading Commonwealth Misses Again

Michael Tanner: Despite Flaws, We’re No. 1

When Italian Prime Minister Silvio Berlusconi needed heart surgery, he didn’t go to an Italian hospital. He didn’t go to Austria or the Netherlands. He had his surgery at the Cleveland Clinic in Ohio. Similarly, when Canadian Human Resources Minister Belinda Stronach needed treatment for breast cancer, she had it done at a California hospital. And, when then-Newfoundland Premier Danny Williams needed to have a leaky heart valve repaired, he had it done at the Mount Sinai Medical Center in Florida.

These high-profile patients were following in the footsteps of tens of thousands of patients from around the world who come to the United States for treatment every year.

They come here because they know that despite its flaws, the U.S. health care system still provides the highest quality care in the world.

More from Michael Tanner in USA Today.

More on How P4P Can Backfire

From the Wall Street Journal,by Katherine Hobson:

[I]n the case of the elderly, [quality indicators] may lead to “unintended harms,” according to a commentary published in the Journal of the American Medical Association.

In general, these indicators encourage physicians to provide more care deemed appropriate, not to pare back on care that is inappropriate, says Sei Lee, an author of the piece and an assistant professor of medicine in the geriatrics division at the University of California, San Francisco. (His co-author is Louise Walter, also at UCSF.)

That means a hypothetical doctor who prescribed medications to everyone who came in the door, whether they needed them or not, could look great according to the indicators, Lee tells the Health Blog.

How Pay-For-Performance Can Backfire

From Health Affairs by Aaron Carroll:

One of the ways you can have really good stats is to treat healthier people in general…. Wealthy people tend to be healthier than poorer people, in general, so focusing your practice in wealthier neighborhoods, and limiting your Medicaid exposure, may tend to improve your outcomes. Minority populations tend to be unhealthier than non-minority populations as well. Therefore, hospitals that tend to have lower numbers of black or Hispanic patients might look better, too.

It gets worse. Because the hospitals that cover more poor people and more minorities tend to cover more unhealthy people, they may spend more money as well. So it’s possible for them to get the worst of both worlds. Their quality looks worse and their costs look higher.

…. There will be a strong impulse to create straightforward metrics like this study used to grade which hospitals are doing “well” and which are “wasting money”. When they do that, and decide to reward those that come out on top, hospitals that need the resources the most may be deprived of them first.

That’s backwards, and avoidable. Disparities will worsen, not improve. You can’t say you haven’t been warned.

See Kaiser story here.

 

In Other Sectors This is What Markets Do

This is from Atul Gawande’s commencement address at Harvard Medical School:

The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves. One needed only an ethic of hard work, a prescription pad, a secretary, and a hospital willing to serve as one’s workshop, loaning a bed and nurses for a patient’s convalescence, maybe an operating room with a few basic tools. We were craftsmen. We could set the fracture, spin the blood, plate the cultures, administer the antiserum. The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.

Continue reading In Other Sectors This is What Markets Do

What? You Don’t Like Your Medical Home?

Patients have not been all that happy with the [patient-centered medical homes], according to early research.  Pauline Chen’s New York Times article brought patients’ dissatisfaction with the PCMH to the public discussion last July. Citing reports from 36 practices participating in the PCMH National Demonstration Project, she noted that patients felt disoriented, displaced as team care replaced the one-to-one patient-doctor interactions.  The article asserts that patient satisfaction fell because few patients were aware of or involved with the changes going on around them.

Full article on the patient-centered medical home.

Canada Still Working Towards Health Care For All

You probably didn’t notice, but Canada will have a federal election on May 2. It’s a big deal up there — and the number one issue is — you’ll never guess — health care! It’s eleven percentage points more critical than jobs and the economy, according to this poll.

Canada, of course, is the model for so-called single-payer, government monopoly health care. But the polls tell us that all is not well. The monopoly has been effectively closed since 1984, when the federal government prevented doctors who operated in the system from balance billing or operating outside the system. If any country should have gotten its act together on ensuring access to adequate care, surely it would be Canada.

Or, it would be if government planners could bring about such outcomes. In fact, five million Canadians have no access to a primary care physician. (That’s about 15 percent of the population.) Remarkably, the Canadian people’s response to this astounding government failure is to support government-run health care by a ratio of nine to one.

Continue reading Canada Still Working Towards Health Care For All

Beam Me Up Scotty

As I have said many times before, Paul Krugman doesn’t know anything about health care. Here he is writing in The New York Times:

“Consumer-based” medicine has been a bust everywhere it has been tried…… America has the most “consumer-driven” health care system in the advanced world. It also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries.

To which Megan McArdle replied: if consumer-driven care means more out-of-pocket spending, the US is in the middle of the pack. See the graph:

And if it means people choosing their own health plans, Switzerland is the world’s leader on that score. As Tyler Cowen pointed out, Krugman himself praised the Swiss system in an earlier editorial.

See Aaron Carroll here.

Health Care Quality

We have probably destroyed a good sized forest supporting all the hundreds (thousands?) of articles, posts and commentaries decrying the failure of the U.S. health care system to meet higher standards of quality. But why do we have a quality problem? I know of not a single page of explanation.

Until now. A post at the Health Affairs blog is the first of a three-part blog giving the answer — based on a paper written by Gerry Musgrave, Devon Herrick and yours truly.

I will blog on this here in the near future.