Quality of U.S. Health Care, Part Four

Crossing the Quality Chasm and To Err is Human.

I have stated that the equity issue in the U.S. is one primary reason that the U.S. has a lack-luster performance record when compared to other countries, but I’ve also warned that cross-country comparisons are not the only standard. These two reports from the Institutes of Medicine, above, offer a good review of the literature, and I believe offer a compelling argument for the less than ideal care that we receive. These reports do not use cross-country comparisons, but generally, look at the care one should receive and the care we do receive. They label the errors as overuse, underuse, and misuse (and they acknowledge that the quality is lacking). First, what should be said, and I don’t believe that I have emphasized this enough – the U.S. (and the world to maybe a lesser extent) has made remarkable strides in health technologies, pharmaceuticals, diagnostics, and therapeutics. Our doctors can do amazing things. Their training is exceptional and all of these advances have pretty much exploded since the end of WWII. These reports point out that no single doctor can keep all of the complexities in their head. Further, as we increase the life expectancy we have a population living with more and more chronic conditions and comorbidities (meaning they have heart issues, diabetes, and a cancer history) further complicating the doctor’s job. The problem is not with our knowledge base (we can always learn more, but our learning curve is steep), but with our ability to organize this knowledge and to administer the knowledge in a safe and efficient manner. The problem is with the delivery system. We have inadequate systems and databases for tracking patients, for preventing errors (computers can catch negative drug interactions for example), for storing medical information, and for clinical communication. Basically, we have had an amazing explosion of medical advances and a woefully out-dated system that cannot keep up. It’s like giving a new teenage driver a 500 hp sports car. Accidents are unavoidable. Errors are bound to happen. We need a new delivery system. We need better health information technology, drug delivery systems, medical databases, and safeguards that limit doctor errors. Why don’t we have these things? Our system is too complex and too decentralized to integrate.  We have too many players and a very limited capacity to organize them.


3 responses to “Quality of U.S. Health Care, Part Four

  1. Would either a universal care system or a single-payor system address the problem of decentalization of information?

  2. Universal health care is too broad of a category to know whether it would help with decentralization of information. Single payer, a type of universal health care, would certainly centralize information. The VA, a single payer system, is noted to have good health information technology. I would say that universal health care as a broader category would most likely move the system toward a more centralized structure, but at the same time, it is easy to imagine a universal health care scheme that would increase the decentralization of information.

  3. My husband died of small-cell lung cancer in dec,2002.We had no insurance ,because of pre-existing illness we could not get coverage.He was turned away from chemotherapy because of lack of insurance,and not too many Americans could actually pay for it.I had to remove the metal stitiches from his abdomen when the physician did not show up to remove them.At the end of his life they did perform the surgery but it was too late.It was a real life horror story.We need to stop talking and start doing something about the crisis.After wills death i started a foundation to asssist the uninsured.it has been a struggle to get the the help i need everyone is preoccupied wth themselves to even care,not tinking that one day you or someone you love may need assistance from my charity or anyone trying to help people.Those in position seem to only want to help the rich and famous,yet charity begins at home.without the poor there will be no rich we need to remember who is keeping the ecomomy going,why its the poor,we need to get a life and recognize.stop talking and start doing something,there are so many things that can be done aybe if we listen to what the poor is saying we can get true solutions to the problems.The rich know how to make money but the poor people know how to assist their own and make it better for everyone,we need to listen ,learn and give thanks and maybe we might have a better world.

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