Posts Tagged NEJM
Ralph Waldo Emerson is not usually associated with healthcare. However, his famous quote about consistency may apply. The US healthcare system seems to be quite consistent, in a bad way.
The Perspective section of the September 7, 2017 edition of the New England Journal of Medicine featured an opinion article by Eric Schneider and David Squires. The essence of the article is to point out the US healthcare system has a lot of potential, receives lots of money, discovers great treatments and has some institutions that really deliver good care. The authors suggest with a change in focus US healthcare could be number one in the world. Yet, it is not. And, it maintains a poor rating CONSISTENTLY.
The authors state key strategies for improving healthcare:
- Timely access to care (preventive, acute and chronic)
- Delivery of evidence-based and appropriate care services.
They note several things that stand in the way of delivering care of any type:
- Cost of care (US is number one)
- Administrative burden (US is number one)
- Disparities in the delivery of care (US rates very high)
In any large US city the profusion of stand-alone emergency rooms is testament to the failed notion of high-cost rescue treatment rather than low-cost prevention or ongoing monitoring and early intervention. The US tends to invest in high-cost drugs, treatments and surgeries and under-invests in primary care and social services. The failure to adjust the focus of healthcare efforts has become a financial train wreck.
The authors of the above article present four prescriptions for US healthcare:
- Improve access to care
- Increase investment in primary care
- Reduce the administrative burden
- Make healthcare more equitable, so all people can receive good healthcare
However, those lofty goals require something else. The US must stop the foolish consistency of accepting poor health care, of paying too much for healthcare and believing great inventions automatically lead to great healthcare.
Perhaps the Emerson quote is too painful. An Albert Einstein quote may be better:
“The world we have created is a product of our thinking; it cannot be changed without changing our thinking.”
Graph from N Engl J Med 2012; 367:3-6July 5, 2012
The graph above comes from an article in the New England Journal of Medicine by David C. Radley, Ph.D. MPH and Cathy Schoen, M.S. It shows the distribution of uninsured adults across the United States. Large parts of Texas, New Mexico and Alaska have over 50% uninsured adults. Wisconsin and Massachusetts have less than 15% uninsured adults. The graph is the result of an analysis of US Census Bureau data from 2009-2010.
The areas with low rates of insurance are also the areas with other health problems. The authors conclude the uninsured areas are associated with low quality care, poor access to care, unsafe prescribing, increased visits to ER for avoidable conditions, and more avoidable deaths.
The bottom line is the US healthcare system is designed for high cost and low quality care especially for those who choose not to have insurance or those who can not afford insurance. Unless a person is extremely wealthy it is very unwise to forgo insurance in this environment. The maldistribution of insurance enhances the argument for those in states with high rates of insurance not to pay more in taxes to cover those in states with low rates of insurance. It seems strange that the states with enhanced revenue from oil and gas can’t seem to correct the insurance gap.