| Replaced_Texan |
03-15-2006 06:16 PM |
Looming crisis
I posted this article in the New York Review of Books, by Paul Krugman and Robin Wells yesterday, but I think it's important to read today in the context of this study that will be published in the New England Journal of Medicine.
Quote:
BOSTON - Startling research from the biggest study ever of U.S. health care quality suggests that Americans — rich, poor, black, white — get roughly equal treatment, but it's woefully mediocre for all.
"This study shows that health care has equal-opportunity defects," said Dr. Donald Berwick, who runs the nonprofit Institute for Healthcare Improvement in Cambridge, Mass.
The survey of nearly 7,000 patients, reported Thursday in the New England Journal of Medicine, considered only urban-area dwellers who sought treatment, but it still challenged some stereotypes: These blacks and Hispanics actually got slightly better medical treatment than whites.
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The researchers, who included U.S. Veterans Affairs personnel, first published their findings for the general population in June 2003. They reported the breakdown by racial, income, and other social groups on Thursday.
They examined medical records and phone interviews from 6,712 randomly picked patients who visited a medical office within a two-year period in 12 metropolitan areas from Boston to Miami to Seattle. The group was not nationally representative but does convey a broad picture of the country's health care practices.
The survey examined whether people got the highest standard of treatment for 439 measures ranging across common chronic and acute conditions and disease prevention. It looked at whether they got the right tests, drugs and treatments.
Overall, patients received only 55 percent of recommended steps for top-quality care — and no group did much better or worse than that.
Blacks and Hispanics as a group each got 58 percent of the best care, compared to 54 percent for whites. Those with annual household income over $50,000 got 57 percent, 4 points more than people from households of less than $15,000. Patients without insurance got 54 percent of recommended steps, just one point less than those with managed care.
As to gender, women came out slightly ahead with 57 percent, compared to 52 percent for men. Young adults did slightly better than the elderly.
There were narrow snapshots of inequality: An insured white woman, for example, got 57 percent of the best standard of care, while an uninsured black man got just 51 percent.
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The New York Review of Books article is long, but I think that it's essential reading to help understand what the fuck is wrong with our healthcare system.
Quote:
The good news is that we know more about the economics of health care than we did when Clinton tried and failed to remake the system. There's now a large body of evidence on what works and what doesn't work in health care, and it's not hard to see how to make dramatic improvements in US practice. As we'll see, the evidence clearly shows that the key problem with the US health care system is its fragmentation. A history of failed attempts to introduce universal health insurance has left us with a system in which the government pays directly or indirectly for more than half of the nation's health care, but the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals, and other players who add cost without adding value. A Canadian-style single-payer system, in which the government directly provides insurance, would almost surely be both cheaper and more effective than what we now have. And we could do even better if we learned from "integrated" systems, like the Veterans Administration, that directly provide some health care as well as medical insurance.
The bad news is that Washington currently seems incapable of accepting what the evidence on health care says. In particular, the Bush administration is under the influence of both industry lobbyists, especially those representing the drug companies, and a free-market ideology that is wholly inappropriate to health care issues. As a result, it seems determined to pursue policies that will increase the fragmentation of our system and swell the ranks of the uninsured.
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