13 August 2009

Healthcare Improvement

An Op-Ed co-published by Atul Gawande, Donald Berwick, Elliot Fisher, and Mark McClelland:

10 Steps to Better Health Care - NYTimes.com
WE have reached a sobering point in our national health-reform debate. Americans have recognized that our health system is bankrupting us and that we have dealt with this by letting the system price more and more people out of health care. So we are trying to decide if we are willing to change — willing to ensure that everyone can have coverage. That means banishing the phrase “pre-existing condition.” It also means finding ways to pay for coverage for those who can’t afford it without help.

Both of these steps stir heated argument, not to mention lobbyists’ hearts. But what creates the deepest unease is considering what we will have to do about the system’s exploding costs if pushing more people out is no longer an option. We have really discussed only two options: raising taxes or rationing care. The public is understandably alarmed.
It's a little vague, and doesn't contain a simple list of "10 steps" as the title suggests.  However, good stuff nonetheless, and a bit of home-town pride since my institution was one of those cited in the article as a leader in efficiency.

Also worth noting that our institution does not rely on salaried physicians, as do Mayo & Cleveland Clinic, since I think putting docs on salary is an oversimplified way to promote efficiency.  It's no panacea.

The lack of specifics reinforces in my mind one key point: organizational change is hard, and there will be no cookie-cutter solutions.

1 comment:

  1. At this point, although the debate and spin continue, this bill is essentially dead from an emotional and mandate perspective, even if some version gets passed. Whether it ultimately proves to be of any benefit to society, or a detriment, will take years, if not decades, to appreciate.

    This bill, and virtually anything that might be done to improve our healthcare system, involves too much complexity with which we are emotionally motivated to deal. In addition, there are too many factions with entrenched economic and/or financial interests to permit it to become a true health initiative.

    There's been too much arguing about the details. People can not describe in 2 or 3 sentences the conceptual parameters of the effort and what it is supposed to accomplish. Unfortunately, people can describe how they feel about it in 1 or 2 words, and that's not good. And that's not to mention the elements which have whipped up hysteria by suggesting, with certainty, what will occur once the final product (which does not yet exist) emerges.

    If either side of the debate has to work this hard arguing about something which theoretically should improve the lives of the masses of people, there's a big problem.

    Even more so than how something is done, people are interested in results, not the details. And once again, as is frequently the case with much of human processing, the facts don't really matter. How people view the world, what they value, and what they want, matters.

    And there is nothing collaborative in nature about that. Factor in the strong individualistic American DNA, and this effort is emotionally toast.

    Being an optimist, I hope and pray that some improvement in our health status as a nation is made. However, the noise is deafening, and I may need medical treatment for loss of hearing before the debate is over.


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