when it comes to health care, it's a government bureaucracy that's setting the standard for maintaining best practices while reducing costs, and it's the private sector that's lagging in quality. That unexpected reality needs examining if we're to have any hope of understanding what's wrong with America's health-care system and how to fix it. It turns out that precisely because the VHA is a big, government-run system that has nearly a lifetime relationship with its patients, it has incentives for investing in quality and keeping its patients well—incentives that are lacking in for-profit medicine.
National Healthcare for the USA
by sammielee24 348 Replies latest jw friends
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sammielee24
In 1999, the Institute of Medicine issued a groundbreaking study, titled To Err is Human, that still haunts health care professionals. It found that up to 98,000 people die of medical errors in American hospitals each year. This means that as many as 4 percent of all deaths in the United States are caused by such lapses as improperly filled or administered prescription drugs—a death toll that exceeds that of AIDS, breast cancer, or even motor vehicle accidents.
Since then, a cavalcade of studies have documented how a lack of systematic attention not only to medical errors but to appropriate treatment has made putting yourself into a doctor's or hospital's care extraordinarily risky. The practice of medicine in the United States, it turns out, is only loosely based on any scientifically driven standards. The most recent and persuasive evidence came from study by Dartmouth Medical School published last October in Health Affairs. It found that even among the “best hospitals,” as rated by U.S. News & World Report, Medicare patients with the same conditions receive strikingly different patterns and intensities of care from one another, with no measurable difference in their wellbeing.
For example, among patients facing their last six months of life, those who are checked into New York's renowned Mount Sinai Medical Center will receive an average of 53.9 visits from physicians, while those who are checked into Duke University Medical Center will receive only 20.9. Yet all those extra doctors' visits at Mount Sinai bring no gain in life expectancy, just more medical bills. By that measure of quality, many of the country's most highly rated hospitals are actually its shoddiest.
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sammielee24
Vista is a massive computer system that has allowed the VA to streamline and provide families, patients, medical professionals access to immediate information from anywhere on any of their patients.
Developed at taxpayer expense, the VistA program is available for free to anyone who cares to download it off the Internet. The link is to a demo, but the complete software is nonetheless available. You can try it out yourself by going to http://www1.va.gov/CPRSdemo/. Not surprisingly, it is currently being used by public health care systems in Finland, Germany, and Nigeria. There is even an Arabic language version up and running in Egypt. Yet VHA officials say they are unaware of any private health care system in the United States that uses the software. Instead, most systems are still drowning in paper, or else just starting to experiment with far more primitive information technologies.
Worse, some are even tearing out their electronic information systems. That's what happened at Cedars-Sinai Medical Center in Los Angeles, which in 2003 turned off its brand-new, computerized physician order entry system after doctors objected that it was too cumbersome. At least six other hospitals have done the same in recent years. Another example of the resistance to information technology among private practice doctors comes from the Hawaii Independent Physicians Association, which recently cancelled a program that offered its members $3,000 if they would adopt electronic medical records. In nine months, there were only two takers out of its 728 member doctors.
For health-care providers outside the VHA system, improving quality rarely makes financial sense. Yes, a hospital may have a business case for purchasing the latest, most expensive imaging devices. The machines will help attract lots of highly-credentialed doctors to the hospital who will bring lots of patients with them. The machines will also induce lots of new demand for hospital services by picking up all sorts of so-called “pseudo-diseases.” These are obscure, symptomless conditions, like tiny, slow-growing cancers, that patients would never have otherwise become aware of because they would have long since died of something else. If you're a fee-for-service health-care provider, investing in technology that leads to more treatment of pseudo-disease is a financial no-brainer.
But investing in any technology that ultimately serves to reduce hospital admissions, like an electronic medical record system that enables more effective disease management and reduces medical errors, is likely to take money straight from the bottom line. “The business case for safety…remains inadequate…[for] the task,” concludes Robert Wachter, M.D., in a recent study for Health Affairs in which he surveyed quality control efforts across the U.S. health-care system.
As the health-care crisis worsens, and as more become aware of how dangerous and unscientific most of the U.S. health-care system is, maybe we will find a way to get our minds around these strange truths. Many Americans still believe that the U.S. health-care system is the best in the world, and that its only major problems are that it costs too much and leaves too many people uninsured. But the fact remains that Americans live shorter lives, with more disabilities, than people in countries that spend barely half as much per person on health care. Pouring more money into the current system won't change that. Nor will making the current system even more fragmented and driven by short-term profit motives. But learning from the lesson offered by the veterans health system could point the way to an all-American solution.
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wednesday
So that sounds impressive, but what it really means is the insurance / government companies want docs to use old drugs first and only if they do not work progess to better drugs. they want patients out of the hospital before they are really ready. they force people to go home where they often don't have adequate assistance and take care of themselves. I had a first hand experience wiith this this. this is not better care, but it does cut costs. now if I could learn to set my own broken bones, and stitch up a cut., that really would save a lot of cost. .In some cases an older drug is just fine, but a lot of the time a patient can be spared a lot of time, pain suffering etc by just prescribing the right drug to begin with and not trying to use old drugs, ie follow protocol, when newer ones are available and work better. also, but if there is a cancer growing in my body, I don't consider that pusedo -disease. -
sammielee24
Wednesday - the jist of that article (which I had to condense because of length) was that in for profit hospitals - the same people, with the same illness, were compared as far as service. In one hospital, a doctor visited the patient 50 times vs 20 times in the other. Both are top notch hospitals. The patient outcome was identical, but the doctor visiting 50 times, was able to bill for 50 visits, not expecting any better outcome than if he/she had done rounds only 20 times.
In for profit, the point they were making, was that it is for profit. If you have a cough that you and your doctor both think is from the nasty cold you had last week - you will be charged for the doctors visit, checked over physically, blood pressure and sound etc and may be advised as to what to do or possibly pointed in the direction of a medicine that may alleviate your symptoms, but based on profit, it is more advantageous for me to send you for an xray or scan, even though I am sure from your check up that it is just a cough from your cold. That one visit to the xray department will cost you (ex) $1,000 for an outcome that, based on probability, logistics, physical workup and your history, will prove negative. You are out $1,000 bucks to have that negativity confirmed, the doctor has increased his or the hospitals profit. Multiply that by thousands upon thousands of people a day. No one disputes the validity of any test when it is needed but for those without insurance anyway, that test is so far out of reach for them that it remains a moot point.
I felt that the Vista system that was implemented had some extremely good points and proved that depending on who is running the show with strong leadership and direction, there is a solution to improving healthcare even at a governmental level.
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sammielee24
Personally I can't handle the stress of spending my paychecks down to the penny which is what I'd be doing if I insured my child. For my own peace of mind, I need to have that small cash cushion left after the bills are paid. I'm a dice roller, I guess. And it's easier to put the noninsured issue out of my mind when I actually have that surplus on the 14th and the 29th.
You aren't alone.
THE FACTS AT A GLANCE
- The number of kids who go without care because they lack health insurance: 2.8 million
- The number of uninsured children with a parent who is employed full time: 5.3 million
- The increase in probability of death before age one for kids born into uninsured households: 50 percent
- The amount the average monthly health insurance premium has gone up since 1988: 600 percent
Children born into an uninsured household are 50 percent more likely to die before their first birthday. This sounds like a statistic from a third world country, doesn't it? But, according to the 2005 United Nations Human Development Report, this number applies to the United States, one of the richest countries in the world.
There are over eight million uninsured children in the United States, and these kids are 10 times as likely to go without the health care they need as those with insurance. Parents of uninsured children often diagnose and treat their children themselves, making the trade off between paying the rent or mortgage and visiting the doctor. Just one emergency room visit can cost thousands of dollars, enough to put many families in debt.
The results of going without insurance are well known. Uninsured children who have asthma, for instance, are 75 percent less likely to see a physician when they need to than kids with insurance. There is no excuse for a health care system that forces parents to hesitate before calling a doctor when their child is having troubling breathing.Who are these uninsured kids? A little over half of them are children who are eligible for insurance programs such as Medicaid and the State Children's Health Insurance Program (SCHIP), but are not enrolled. There are a variety of reasons for this. For example, there are many parents who find the enrollment process overwhelming; others do not realize they qualify for these programs. What's more, some states have stopped enrolling eligible children in SCHIP because they've run out of money.
And the rest? Over three million uninsured children have working parents. These parents have incomes of over $32,180 for a family of three, meaning they make too much money to qualify for the above programs, but not enough to afford private insurance. Many are children of the one in four Americans - often working moms -- who hold nonstandard temporary or part-time jobs, which rarely offer medical coverage.
On average Americans now switch jobs every five years, and in our current system their insurance does not follow them. As a result, even employed parents often feel they are teetering on the edge of a cliff. As one Parents' Action mom wrote, "When my [husband] changed places of employment four years ago, we lost our health care coverage. Well, I shouldn't put it that way. Of course we would have kept it if we could pay the outrageous premiums, which of course, we couldn't."
And those premiums are increasing at an astounding rate. The average monthly health insurance premium is 600 percent higher today than it was in 1988, rising four times as fast as wages during the same period, according to the Citizen's Health Care Working Group.
Sadly, there is no comprehensive national plan to make sure every child has health care coverage. In fact, the new federal budget proposal for 2007 goes in the opposite direction, cutting current children's health insurance programs (such as SCHIP) by $5 billion. That means even more children will be uninsured and that premiums and co-payments will go up for families who are served by these programs. This proposal comes on the heels of current spending cuts requiring increased co-payments on health care services for 4.5 million low income children. -
LDH
And the rest? Over three million uninsured children have working parents. These parents have incomes of over $32,180 for a family of three, meaning they make too much money to qualify for the above programs, but not enough to afford private insurance. Many are children of the one in four Americans - often working moms -- who hold nonstandard temporary or part-time jobs, which rarely offer medical coverage.
On average Americans now switch jobs every five years, and in our current system their insurance does not follow them.It sucks to be in that situation, making just 'too much' to qualify. I suggest using every deduction they tell you is legal, from child care to elder care expenses.
It is not true that insurance does not follow employees who switch jobs. That was the point of passing HIPAA (Health Insurance Portability and Accountability Act.)
On average, premiums have risen 12% per annum for the past 8 years. This annual increase can not be sustained for much longer and as a result the insurance industry is getting ready to feel the burn, my friends. Mark my words.
Lisa
Watches for Signs Class
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LDH
when it comes to health care, it's a government bureaucracy that's setting the standard for maintaining best practices while reducing costs, and it's the private sector that's lagging in quality. That unexpected reality needs examining if we're to have any hope of understanding what's wrong with America's health-care system and how to fix it. It turns out that precisely because the VHA is a big, government-run system that has nearly a lifetime relationship with its patients, it has incentives for investing in quality and keeping its patients well—incentives that are lacking in for-profit medicine.
Please don't take this out of context.
10 or 15 years ago a Veteran could receive free care regardless of the illness. Now the free care is only for service related injuries or disabilities. The rest is billed to the Veteran's private insurance or medicare/medical/charity.
Trust me on this.
Lisa
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sammielee24
Drug Companies Making Billions in Excess Profits Under Medicare Plan WASHINGTON - August 15 - Pharmaceutical companies are making billions in excess profits under the new Medicare drug benefit, according to a report by the Center for Economic and Policy Research. In the first year of the Medicare Part D program, Pfizer will make $1.2 billion in excess profits on Lipitor and $585 million on Zoloft; Wyeth will make nearly $1 billion on Protonix; and Merck will make $1.6 billion on Zocor. The report, "The Origins of the Doughnut Hole: Excess Profits on Prescription Drugs," by economist Dean Baker, calculated the difference between the average cost of 20 common drugs used by seniors and the cost when obtained through the Veterans Administration. It found excess profits totaling more than $7 billion in the first year of the program. The study also calculated prices for prescription drugs such as Actonel, Aricept, Celebrex, Fosamax, Nexium, Norvasc, Plavix, Prevacid, Toprol XL, and Xalatan. To read the report, see: http://www.cepr.net/publications/part_d_drug_profits_2006_08.pdf
Thousands of drugs cost more than necessary under the Medicare drug plan because Congress prohibited Medicare from negotiating drug prices directly with the pharmaceutical industry, as is done by the Veterans Administration. In the case of many drugs, the prices paid by insurers participating in the plan are more than twice as high as the prices paid by the Veterans Administration.
Millions of seniors and disabled Americans enrolled in Medicare Part D drug plans are discovering the "doughnut hole" - the $2,850 gap placed into the plan in order to save the government money. The Center for Economic and Policy Research has pointed out that this gap was only necessary because the plan's overall design added significant costs and complexity.
"The excess profits from just a small number of drugs account for a very large portion of the doughnut hole," said Baker. "The excess profits for the drug industry as a whole will be close to $50 billion in the first full year of Medicare drug benefit program. This is more than twice the size of the doughnut hole."
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LDH
Swife,
you need to read this story. It ran in today's Fresno Bee. It's about Community Medical Center's poor financial performance. They are a non-profit hospital. I'll post the link to the story but please meditate on this paragraph for a while. Not in any particular order but I think it highlights specific problems.
Community's two biggest hospitals lost money on four out of five patients last year and posted operating losses of more than $54.5 million since 2003, according to state data. Officials mainly blame government reimbursement rates that lag behind rising treatment costs.
.....Community saw a sharp rise in the number of patients on Medi-Cal, the state's health-care program for poor children and adults. Reimbursement rates didn't keep up with soaring medical costs; Community officials also say their newfound government subsidy hit a roughly $40 million ceiling imposed by the Legislature.
......Joslin said the county's contract with Community was well-intentioned. But no one projected market changes that forced the nonprofit to shoulder an ever-expanding number of poor and low-paying patients, he said.
......Even when Community lured the PacifiCare HMO contract in 2001 away from Saint Agnes — worth an estimated $52 million — it backfired. County employees represented a chunk of PacifiCare's estimated 61,000 members, and many didn't want to go to Community hospitals.
The private hospital system already treated patients with insurance or under government programs such as Medi-Cal and Medicare. With the new contract, it also assumed the county's legal duty to care for jail inmates and the indigent — generally the poorest of the poor who don't qualify for other government programs, including many illegal immigrants.
Though flush early on, Community began bleeding cash as it lost doctors and higher-paying patients to northern competitors, invested hundreds of millions of dollars in construction projects and cornered the market on the poorest, sickest and worst-paying clients.
http://www.fresnobee.com/local/story/12612771p-13318370c.html
Before we could EVER move to NHS, don't you think we must address how the reimbursement contracts are drawn up? I've asked this question no less than 3 times on this thread and it's gone ignored. Government-decided reimbursement rates BANKRUPT medical facilities. I posted text from the proposed Shiela Kuhl bill on government run health care and it indicates that reimbursements will be recalculated every three years.
Healthcare will become a rationed product under the current proposals.
Lisa