We call it health care; let's think about what the words mean. The implication is that some group is providing care that leads to health or a healthy life. That's not exactly true. We each are responsible for our own health. Some of it can be affected by the choices we make, some is beyond us (environment, genetics, accidents, etc.), some depends upon getting quality care when we are sick or injured. Regardless, the people and organizations that provide "health care" do not really purport to make us healthy. We show up at their offices when we need a service. They provide medical care for us.
Why does it matter? When judging how good a job medical services providers do, we need to concentrate on how well they do at tending to our sicknesses and injuries not how healthy we are in general. They can affect the former; not so much the latter.
Some analysts judge the medical services provided in the US to that of other countries by looking at a calculation called life expectancy. The fact that the life expectancy at birth in the US is among the lowest of developed countries and ranks with some developing countries is taken as proof that the high cost of health care in the US is wasted.
Life expectancy does measure health outcomes but is a poor indicator of the quality and effectiveness of the services of medical providers. Life expectancy is the result of all inputs. Adjusting for differences in just violent deaths, the US has among the highest life expectancies.
Broad statistics describing the health of the population are inappropriate to use in judging the effectiveness of the providers of medical services that we commonly call health care providers. In later posts, I'll look at some outcomes that directly go to the quality of care.
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The adjusted calculation of life expectancy comes from a book entitled "The Business of Health" by Robert Ohsfeldt and John Schneider. You can read it in a pdf here.
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Some HMOs (Kaiser comes to mind) have elaborate systems for "grading" their primary care doctors. These grades link payment to the ability to document M.D.s providing evidence based preventative medicine to patients.
ReplyDeleteDo you have diabetes? In addition to your diabetic medicines, you should be on an ACE-inhibitor (a particular variety of blood pressure medicine protective to the kidneys) and a cholesterol medicine. If you're not, your doctor needs to document why not at each and every encounter.
While this certainly has its use in certain applications, Medicare would like to apply this model to every aspect of health care. There isn't enough space here for me to adequately list all the reasons why that's a bad idea, but let me sum it up: each patient is an individual. Presumably, they would like to continue to be treated as such.