IOM Report — What Is Missing

The IOM is a government organization that studies medical care and issues reports.  The reports are scholarly and well regarded.  Below is an excerpt from a recent 380 page report.



*Best Care at Lower Cost: The Path to Continuously Learning
Health Care in AmericaReleased:September 6, 2012America’s health care system has become far too complex and costly to continue business as usual. Pervasive inefficiencies, an inability to manage a rapidly deepening clinical knowledge base, and a reward system poorly focused on key patient needs, all hinder improvements in the safety and quality of care and threaten the nation’s economic stability and global competitiveness. Achieving higher quality care at lower cost will require fundamental commitments to the incentives, culture, and leadership that foster continuous “learning”, as the lessons from research and each care experience are systematically captured, assessed, and translated into reliable care.

The full report is available online and worth reading.

What is the bottom line?

There are numerous areas where US health care wastes money and delivers poor care.  The wasted money is estimated at over $750 billion dollars each year.  The IOM opines an environment where everybody has the attitude of  gladly improving health care so each problem could be addressed and by an evolutionary process the US would end up with a great health care system.

Frankly, it ignores working  health care systems in other countries and fails to outline a structure for management of US health care.   All great quality improvement ideas fail without a structure .   From a political standpoint the question will be “what am I buying”?   The answer “the cost will evolve” is just not adequate.

So, in the absence of structural suggestions here is a place to start:

This system replaces all existing government health care agencies with an insurance system covering “basic care benefits”.  All private insurance would offer the basic care benefit with insurance add-on products as desired.

Top level:  Administrator
Department:  United States Health Care (USHC)
Funded by:  Congress (has a budget each year)
Subdivisions:

  • Office of budget compliance with regional offices (comptroller)
  • State divisions of quality improvement
  • National drug and equipment evaluation and approval (formulary)
  • Office of hospital, specialist, device and prosthetic payments
  • Office of primary care and drug payments
  • National patient registry
  • Office of basic care benefits
  • Office of national health records (System wide EMR)
  • Office of health research integration
  • Office of manpower training (free training in exchange for service)

Now we are getting somewhere.  An administrative structure and a payment structure.  There is huge efficiency by consolidating current US agencies like Medicare, Medicaid, Veterans Health System, Indian Health Service and all others.  Private insurance is encouraged for those items not covered by basic care benefits (e.g. heart transplants, cosmetic surgery, fertility services, extremely expensive chemotherapy etc).

You may say the forgoing is just not possible for the US.  But, consider the idea as restructuring,  a management technique used by large companies all the time.  The IOM says change is needed but we need that change NOW — we need to think like a large company and get the job done.

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