US Healthcare: Running hard, going nowhere?
There's arguably been no two documents that have influenced the debate over the quality of US healthcare more than the Institute of Medicine's 2000 report
To Err Is Human
, and its follow up
Crossing the Quality Chasm
.
Both reports laid out in excruciating detail where the holes existed, and some of the statistics they revealed were truly horrifying. Who can't resist a shudder at the finding that between 44,000 and 98,000 Americans may die every year due to clinical error?
Underlying all of the arguments in favor of increased use of health IT and such things as electronic health records is the understanding that the more hard evidence you can collect about how health care is delivered and how good it is, then you can design a system that will be even better in the future.
Shudder anew, then, at the IOM's
most recent report
, a review of a recent roundtable it conducted to look at what the effect those two studies have had on US health care. Not much, it seems.
The report lays it out in pretty stark terms:
Although these reports sounded appropriate alerts and have triggered important discussion, as well as a certain level of action, the performance of the healthcare system remains far short of where it should be.
Evidence on what is effective, and under what circumstances, is often lacking, poorly communicated to decision makers, or inadequately applied, and despite significant expenditures on health care for Americans, these investments have not translated to better health. Studies of current practice patterns have consistently shown failures to deliver recommended services, wide geographic variation in the intensity of services without demonstrated advantage (and some degree of risk at the more intensive levels), and waste levels that may approach a third or more of the nation’s $2 trillion in healthcare expenditures.
In performance on the key vital statistics, the United States ranks below at least two dozen other nations, all of which spend far less for health care. (emphasis inserted)
That last point is worth noting, over and over again.
I recently went to see
Michael Moore's Sicko