Why Can’t We Get Health Care Right?

Posted on | December 12, 2007 | Comments Off on Why Can’t We Get Health Care Right?

Too much focus on cost, not enough on outcomes

What is it about the US healthcare system? Why can’t we seem to get it right? How can we spend nearly 16% of our GDP – trillions of dollars – annually, and still be mired among the lower tier of nations in health quality? And why do countries that rank above us in quality measures spend much less?

Good questions, all; and although the answers are not easy, they’re relatively simple.

First of all we don’t really have a health care system. Indeed, where we spend the largest portion of this amount on sick care, not health care. In fact, virtually our entire fragmented system is focused on sick care. Many researchers have shown that doing simple things in the wellness universe – broad application of immunizations, annual screenings for early detection of cancers, diabetes, cardiovascular risk factors, etc. – remarkably improves outcomes, and decreases sick care.

Secondly, our entire system focuses on costs; not on outcomes. It is disappointing that of the health reform plans advanced by all of the presidential candidates, every one of them mentions controlling costs as the primary goal of their proposals. Care models in the US that have shown success, most notably the Community Care of North Carolina model that creates a “medical home” for all NC Medicaid recipients, have shown conclusively that focusing on maintaining health and putting quality outcomes first not only can achieve those goals, but they also save dollars! Check out the experiences of this effort at the Community Care of North Carolina website.

Some important examples of our lack of attention to outcomes:

Early detection of colorectal cancer can lead to a cure, whereas late detection usually leads to terrible and tragic outcomes. Screening for this curable cancer is easy enough. But only about 29% of Americans who should have screening actually have it.

Immunizations hold one of the most vital keys to disease prevention ever developed. In fact, the only infectious disease ever eradicated was eradicated not by a super antibiotic, but by an immunization with the broadly applied smallpox immunization program. Infant vaccines have been a mainstay in preventing diseases that were major causes of childhood illness and death just a few generations ago. The newest vaccinations can prevent one of the most deadly cancers in women – the HPV vaccine, one of the most painful and debilitating diseases in the elderly – shingles, most cases of the most common type of community-acquired pneumonia – pneumococcal vaccine, and hepatitis B – one of the most debilitating and deadly forms of the liver disease. And yet most people in this country are not up-to-date on their immunizations, and some “health” plans – they shouldn’t even be allowed to use the word! – don’t cover these incredibly important and effective tools.

And you know what makes this all even more painful? Researchers have shown over and over that each of these interventions – immunizations, appropriate screening and early detection, and others – not only can significantly improve morbidity and prevent mortality, but also save dollars. Not just a few dollars, but potentially billions of dollars!

And finally, we as consumers share in this fragmentation. We believe that in healthcare, as in life, “more is better.” In fact, that could not be more wrong – or more dangerous. In most cases, the more things we have done, the greater the likelihood for error and complication. Research upon research has shown that, whatever our age, minimal for most things is probably better.

I say that we begin to demand from our “health” care system a new focus on health and best outcomes. Let’s demand from our candidates a focus on quality rather than cost. And let’s take some responsibility for ourselves to be good consumers of care based on quality outcomes.

(Michael Fleming, MD, is a family physician from Shreveport, LA and former president of the American Academy of Family Physicians. He can be reached at [email protected]. Opinionsexpressed by Health Commentary guest bloggers do not necessarily represent the views of Health Commentary.)