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| 5/23 |
| 2006/3/15-17 [Health/Disease/General, Health/Dental] UID:42253 Activity:low |
3/15 Most people in America - rich, poor, young, old - receive mediocre
medical care.
http://news.yahoo.com/s/ap/20060315/ap_on_he_me/mediocre_health_care
\_ Hmm, I haven't read the article, but this brings to mind a
discussion I had with my grandmother regarding the pros and cons of
universal health care. The outcome was basically that socialized
medicine raises the minimum care level for everyone, but
potentially lowers the maximum care level for those who have the
means and desire to pay for better care. -dans
\_ In other news, fire is hot, water is wet, all babies must eat,
'bad' means 'good' when teenagers or dans say it.
\_ What the fuck are you talking about? -dans
\_ I think the guy was saying he or she was annoyed by
obviousness + wordiness.
\_ Most Americans/motd readers are not familiar with
foreign health care systems. For example, the only
option for healthcare in the UK is the National Health
Service. Thus, if a Briton wants healthcare services
that the NHS is unwilling or unable to provide, he must
seek them outside of the UK. This option is only
viable for the super-wealthy. Granted, I'm neither a
UK citizen nor an expert on foreign health care so my
facts may be off. I fail to see how this is obvious.
-dans
\_ I think the guy thought the obvious part was
socialized medicine == minimum care level for
everyone increases (by definition), and maximum care
level for the rich potentially decreases.
Anyway, you have undergrads to near 40-year-olds on
soda, so you probably got a cranky alumnus annoyed.
\_ *nod* I consider it my solemn duty to annoy
cranky alumni. Of course, I also happen to be
one, which is probably why I bother reading the
motd. :) -dans
\_ socialized * raises the minimum level (often from 0) for everyone
but usually lowers the maximum level available
\_ It is noteworthy that it doesn't have to lower the max level. A
private elite care system layered over the socialized
infrastructure should allow the same max, unless innovation
is harmed by lost profit potentials in some way (drug
development?) or some kind of lower overall efficiency (not
obvious).
\_ Ah, but look at our schools. The affluent being able to
opt-out of having their kids exposed to public education has
reduced the quality of the public system.
\_ Prove it. (also the max is still high, which was my point)
\_ Currently, approx 1/3 of all the money spent on healthcare is
spent on PAPERWORK, so think of the efficiency improvement if
that could be reduced to 5% or lower.
\_ Medicare's administrative costs (includes paperwork) are
approximately 1%. -dans
\_ my googling is showing 3% Medicare, 15-25% HMOs.
-someone else
\_ mea culpa. Even so, 3% < 5%, and still kicks the
shit out of private healthcare systems. -dans
\_ Are you arguing for or against the socialization? I don't
see paperwork necessarily being much better for either.
\_ Although I'm not saying Canada's system is perfect,
it seems pretty clear that it has less paperwork:
http://tinyurl.com/equd5
"On a visit to the 900-bed Toronto General, Dr.
Himmelstein recounts searching for the billing office;
it ended up being a handful of people in the basement,
whose main job was to mail bills to US patients who
had come across the border."
"Back in Boston, Himmelstein visited Massachusetts
General Hospital, which was similar to Toronto
General in size and in the range of services
provided. He was told that Massachusetts General's
billing department employed 352 full-time personnel,
all of them fighting tooth and nail with hundreds of
insurance plans, each with their own rules about how
to document every item used for every patient."
\_ How is that different from what we have today? I can go into
my employer provided (crappy but free) Kaiser system and I
might survive a serious illness, or do POS/PPO which costs
more but I'll live or do cash-only out of pocket for all
services which will cost me less/year for normal services but
wipe me out for a major issue. If I was rich I'd get
fantastic service and survive.
\_ It isn't really, except we still have lots of people
uncovered, so that baseline isn't very good or very
solid. I'm just responding to the previous posters.
\_ The difference is that today the onus is on employers to
provide healthcare, and many part-time/low-wage workers do
not have healthcare as a result. The high cost of
healthcare for uninsured individuals disincentivizes them
from seeking out preventative care, thus increasing the
risk that they will need urgent/emergency care. Emergency
care is more costly, and puts a greater strain on the
entire system, which pushes prices up for *everyone*. -dans |
| 5/23 |
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| news.yahoo.com/s/ap/20060315/ap_on_he_me/mediocre_health_care AP Study: Most Get Mediocre Health Care By JEFF DONN, Associated Press Writer 41 minutes ago BOSTON - Startling research from the biggest study ever of US health care quality suggests that Americans -- rich, poor, black, white -- get roughly equal treatment, but it's woefully mediocre for all. click here "This study shows that health care has equal-opportunity defects," said Dr. Donald Berwick, who runs the nonprofit Institute for Healthcare Improvement in Cambridge, Mass. New England Journal of Medicine , considered only urban-area dwellers who sought treatment, but it still challenged some stereotypes: These blacks and Hispanics actually got slightly better medical treatment than whites. While the researchers acknowledged separate evidence that minorities fare worse in some areas of expensive care and suffer more from some conditions than whites, their study found that once in treatment, minorities' overall care appears similar to that of whites. It doesn't matter whether you're rich or poor, white or black, insured or uninsured," said chief author Dr. Steven Asch, at the Rand Health research institute, in Santa Monica, Calif. The researchers, who included US Veterans Affairs personnel, first published their findings for the general population in June 2003. They reported the breakdown by racial, income, and other social groups on Thursday. They examined medical records and phone interviews from 6,712 randomly picked patients who visited a medical office within a two-year period in 12 metropolitan areas from Boston to Miami to Seattle. The group was not nationally representative but does convey a broad picture of the country's health care practices. The survey examined whether people got the highest standard of treatment for 439 measures ranging across common chronic and acute conditions and disease prevention. It looked at whether they got the right tests, drugs and treatments. Overall, patients received only 55 percent of recommended steps for top-quality care -- and no group did much better or worse than that. Blacks and Hispanics as a group each got 58 percent of the best care, compared to 54 percent for whites. Those with annual household income over $50,000 got 57 percent, 4 points more than people from households of less than $15,000. Patients without insurance got 54 percent of recommended steps, just one point less than those with managed care. As to gender, women came out slightly ahead with 57 percent, compared to 52 percent for men. There were narrow snapshots of inequality: An insured white woman, for example, got 57 percent of the best standard of care, while an uninsured black man got just 51 percent. "Though we are improving, disparities in health care still exist," said Dr. Garth Graham, director of the US Office of Minority Health. Graham, who is black, pointed to other data showing enduring inequality in care, including a large federal study last year. He also said minorities go without treatment more often than whites, and such people are missed entirely by this survey. Some experts took heart in the relative equality within the survey. Tim Carey, who runs a health service research center at the University of North Carolina-Chapel Hill. But all health experts interviewed fretted about the uniformly low standard. "Regardless of who you are or what group you're in, there is a significant gap between the care you deserve and the care you receive," said Dr. Reed Tuckson, who is black and a vice president of United HealthGroup, which runs health plans and sells medical data. Health experts blame the overall poor care on an overburdened, fragmented system that fails to keep close track of patients with an increasing number of multiple conditions. Quality specialists said improvements can come with more public reporting of performance, more uniform training, more computerized checks and more coordination by patients themselves. The information contained in the AP News report may not be published, broadcast, rewritten or redistributed without the prior written authority of The Associated Press. |
| tinyurl.com/equd5 -> www.mindfully.org/Health/2004/Red-Tape-Healthcare16jan04.htm Red Tape One-Third of All Healthcare Money Spent on Paperwork MATT BIVENS / The Nation 16jan04 Talented, dedicated professionals armed with high-tech equipment take care of our health. But acres of forests and of time--and about $400 billion, or nearly one-third of all the money spent on health care--is just for the paperwork. And according to the comprehensive study by researchers from the Harvard Medical School and from Public Citizen that produced this estimate, some $286 billion of that is utter waste--spending which could be jettisoned overboard by switching to a Canadian-style system. In Canada--where they spend half as much on health care yet have universal coverage and live two years longer than Americans--doctors use a single simple form to bill one insurance plan, and hospitals negotiate an annual budget with a single agency. Some of the Democratic presidential candidates are advocating a switch to a Canadian-style single-payer system. If doing so would indeed save in the ballpark of $286 billion--well, this would be a classic case of having our cake and eating it. Compare that $286 billion savings to the estimated $80 billion cost of insuring every American. Or to the $53 billion price-tag for covering out-of-pocket prescription drug costs not just for seniors--but for everyone. The study's authors note that there would even be, say, $20 billion or so--roughly what we're spending to "rebuild Iraq"--left over to help all of the instantly obsolete bureaucrats of the current system land on their feet. Keep in mind that this study, published today in the International Journal of Health Services, isn't one of those exercises in hazy crystal-ball gazing so common in discussions of economics, science or policy priorities. It's a simple accounting problem--a real-world survey of what the Canadians spend on health care, and what we do. In that spirit, consider the real-world comparison offered by Dr. David Himmelstein, an associate professor of medicine at Harvard and co-founder of Physicians for a National Health Program, of two similar-sized and equipped hospitals: Toronto General Hospital and Massachusetts General. it ended up being a handful of people in the basement, whose main job was to mail bills to US patients who had come across the border. Canadian hospitals get an annual budget from their region's health plan--and a monthly check--and so they don't have to keep track of who received each Band-Aid, only how many Band-Aids overall were used. "It need not fight with hundreds of insurance plans about whether each day in the hospital was necessary, and each pill justified," Dr. "The result is massive savings on hospital billing and bureaucracy." Back in Boston, Himmelstein visited Massachusetts General Hospital, which was similar to Toronto General in size and in the range of services provided. He was told that Massachusetts General's billing department employed 352 full-time personnel--all of them fighting tooth and nail with hundreds of insurance plans, each with their own rules about how to document every item used for every patient. |