One of the most difficult discussions Americans can have with each other about U.S. healthcare is around the question of "quality." How good (or bad) is the typical care that a typical American gets?
When some people hear that the U.S. ranked 37th in the World Health Organization's ranking of national healthcare systems, they often balk...."America has some of the best hospitals, doctors, and healthcare innovation in the world!", they usually respond. And they are right.
But they've missed the deeper issue in the rankings, which gauge the overall, systemic quality of healthcare for entire national populations. The broad demographic reality of America healthcare (and the health of many Americans) often belies the quality of one's own experience with healthcare.
For example, from living in the New York metropolitan area, and having enjoyed the best coverage that corporate America can provide for most of my career, I'm sure that the quality of care my family and I have received is probably as good as it gets anywhere in the world.
But the larger reality, and bigger question is, how many of the 300 milllion other Americans are getting anything like the care and coverage I've experienced?
What such studies and rankings reveal is not that there's is anything inferior about the skills or professionalism of American healthcare professionals, but of the system (or lack thereof) for delivering care to the fullest swath of the U.S. population. To paraphrase William Gibson, I believe, about the future..."advanced healthcare is here, it's just not equally distributed."
What prompted this post (which is my own opinion and doesn't reflect any IBM policies or points of view) is seeing the documentary, "Sicko," and reading a recent NYTimes editorial. Here's an excerpt:
World’s Best Medical Care?
Many Americans are under the
delusion that we have “the best health care system in the world,” as
President Bush sees it, or provide the “best medical care in the
world,” as Rudolph Giuliani declared last week. That may be true at
many top medical centers. But the disturbing truth is that this country
lags well behind other advanced nations in delivering timely and
effective care.
Michael Moore struck a nerve in his new documentary, “Sicko,” when
he extolled the virtues of the government-run health care systems in
France, England, Canada and even Cuba while deploring the failures of
the largely private insurance system in this country. There is no
question that Mr. Moore overstated his case by making foreign systems
look almost flawless. But there is a growing body of evidence that, by
an array of pertinent yardsticks, the United States is a laggard not a
leader in providing good medical care.
Seven years ago, the World Health Organization made the first major
effort to rank the health systems of 191 nations. France and Italy took
the top two spots; the United States was a dismal 37th. More recently,
the highly regarded Commonwealth Fund has pioneered in comparing the
United States with other advanced nations through surveys of patients
and doctors and analysis of other data. Its latest report, issued in
May, ranked the United States last or next-to-last compared with five
other nations — Australia, Canada, Germany, New Zealand and the United
Kingdom — on most measures of performance, including quality of care
and access to it. Other comparative studies also put the United States
in a relatively bad light.
One of the problems with our healthcare quandary is that some folks feel that these sorts of reports or data aren't empirical, objective realities, but some kind of subtle attack or denigration of America. To suggest that America is wanting on a front as important as healthcare may seem to some like an almost unpatriotic act, rather than just the cold hard facts.
Fortunately, there are some things that virtually all Americans can agree on. In a February 2007 poll, 91 percent believe health
care in America needs reforming. Sixty-four percent of those polled in October
2006 would prefer universal health insurance, even if it meant higher taxes.
When 1,229 adults nationwide were asked in January 2006 if health insurance
should be guaranteed for everyone, 62 percent said yes. In the same poll, 61
percent said they were concerned “a lot” about health care costs they are
facing or will face.
One issue we also need to face is that improving the quality of such a large system -- 300 million people in the United States -- is a matter of national competitiveness as much as anything. America needs to be as attractive a place to work as Australia, Germany or any of the other developed and developing nations, and today, the quality of national healthcare is not one of strongest selling points.
Finally, I also wanted to comment on another surprising article in the Times -- Free Lunch on Health? Think Again --which reported that there is no concrete evidence that healthcare systems that emphasized prevention and management of chronic diseases don't neccessarily save money over those that do.
For argument's sake, let's assume that this assertion is true. Well, even if a system that didn't save money by encouraging people to be healthy and manage chronic diseases better is clearly prefereable, because the overall quality of people's health would be better for the same dollars spent. In fact, one of the chief problems is that America spends enormously on healthcare, but doesn't have anything like the quality results to show for it. How much would you pay to live in a culture or country where life expectancies were higher?
Lastly, just because no study has yet showed the economic value of a preventative-oriented system doesn't mean that such savings are not possible. The experiement may need to be much larger to make the case either way, and such an approach would be worth trying simply because it would be likely to improve the health of many individuals, even if cost savings were marginal.
I'll leave you with one insightful response to the No Free Lunch article on the need for health-serivces research:
"It has been established that Americans are receiving the right health
care (including preventive care) only about one-third of the time — the
other times we are either getting no care or the wrong care. And that
only includes the “wrong care” that we know about so far — there is a
lot still to know about what works and what doesn’t — and the kind of
research that sorts that out is health-services research. We currently
spend about $6,700 per American per year on health care, but only $1
per American per year on health services research. We not only need to
conduct more health-services research, including “outcomes” research,
but we need to make the results of that research — including that which
has already been conducted — available to patients, providers,
insurers, employers and federal and state agencies. We can’t expect
people to receive the right care if they don’t know what it actually is." -- Mary Woolley
Bill Rapp
IBM CTO, healthcare 
Dan Pelino, IBM's general manager of global healthcare & life sciences
industry. 
Dr. Paul Grundy, chairman of Patient-Centered Primary Care Collaborative (PCPCC) and IBM's director of Healthcare Technology and Strategic Initiatives. 
In the last 12 years since I’ve been involved in the world of connected health, I’ve strived to read at least one important book each summer, while on holiday. In theory, this keeps one’s mind off of the Blackberry and enables transformative thinking in one’s approach to organizational leadership and strategy. Of course it doesn’t always work that way. Twelve years ago,
Recent Comments