Comments on: Myth No. 1: Quality of Care in the U.S. Health System is the Best in the World

By: HealthViewX

HealthViewX — Thu, 15 Nov 2018 06:05:17 +0000

A good read, well-written post. Today with new innovative IT solution providers are able to achieve quality healthcare and better patient outcomes. Patient referral management solution will be of great help to retain patient within your network and at the same time provide quality care.

By: Rajat Sharma

Rajat Sharma — Tue, 12 Jun 2018 11:13:27 +0000

We spend more for healthcare than any other OECD nation as measured by the portion of our national economy allocated to health spending. All of the other 34 OECD nations allocate 13.1% of less of their economy to health spending. In 2016, our nation’s health spending represented 18.0% of the national economy. The difference in 2016 between 13.0% and 18.0% represented nearly $1 Trillion, the cost of fighting 10 Iraqi/Afghanistan Wars in 2005.

By: erikvaldmir

erikvaldmir — Mon, 02 Apr 2018 13:42:42 +0000

I have just found out something that supports this myth. Recently, World Economic Forum (WEF) has ranked America at number 37 on the list of 137 countries in their annual Global Competitiveness Report 2017–2018 stating that Life expectancy in the United States declined to 78.6 years in 2016.

By: Paul @ Pivot ConsultingLLC

Paul @ Pivot ConsultingLLC — Thu, 08 Mar 2018 14:00:28 +0000

“Health services researchers have correlated adherence to evidence-based clinical practices with better outcomes and lower costs. ” citation please.
“. The results of these efforts are clear and positive.” …re quality initiatives/evidence based initiatives”…a cursory review of THCB suggests this is far from clear.
And see Allan’s insightful comment below.

By: Allan

Allan — Thu, 08 Mar 2018 03:46:10 +0000

It’s very hard to do cross-national comparisons. The question is what are you comparing? Many of the comparisons involve equal treatment, whatever that may mean. Unfortunately, a bullet to the head of all patients with a specific disease can improve one’s egalitarian ratings. Thus when we look at ratings the criteria used creates high ratings for many things that have to do with things other than the healthcare system’s ability to treat.

Take the CONCORD study. It compared international outcomes on 8 common cancers. The US rated #1 or #2 in outcomes (will I live or die? Will I get better? ) No other country rated as well as the US. Take infant mortality where supposedly we rate poorly. If one were to rate infant mortality based on birth weight we are the best in the world. The problem is that countries rate things differently. At least in the recent past France and Switzerland would let newborns die on the table if they were below a certain weight or height and call them miscarriages. Of course, their statistics look better since we will treat an anencephalic newborn until the newborn dies and score it as a death. Unfortunately, we have a lot of socio-economic problems so crack mothers will have low birth weight infants leading to a high mortality. Is that mortality due to the way the healthcare system works? No. That is a socio-economic problem being mixed with our healthcare system’s problems leading us to create numbers that are totally meaningless.

The real myth involves the use of rating scales that compare apples to oranges and lead to the wrong conclusions.

By: Barry Carol

Barry Carol — Wed, 07 Mar 2018 20:15:50 +0000

I think the perception and opinion among many that American healthcare is the best in the world relates primarily to what Don Berwick calls rescue care. Rescue care includes sophisticated surgical procedures to address life threatening conditions, organ transplants, advanced cancer treatment, trauma care, intensive care for very low weight premature babies and access to the newest drugs, especially expensive specialty drugs, among other things. I don’t think it’s an accident that lots of wealthy foreigners choose to come to the United States to access the most sophisticated care that may not be as good or even available at all in their home countries. They’re even willing to pay full charges for their care. I think that speaks volumes.

All the arguments over average life expectancy, infant mortality, access to primary care and the like have little relevance in this context. Moreover, cultures vary a lot among countries. The U.S. is a more litigious society. People are less accepting of death at the end of life and may want lots of care that medical professionals would consider marginally useful at best or even futile. .I think care quality, while difficult or even impossible to measure precisely, is in the eye of the beholder and depends a lot on what the patient is trying to accomplish.

By: William Palmer MD

William Palmer MD — Wed, 07 Mar 2018 18:19:01 +0000

We would probably all agree that there is some “art” in health care. E.g. the placebo effect is real and is applied unevenly by different practitioners. Confidence, trust, skill in communication, agreeable personality, bedside manner must have some clinical effect on outcomes because we know that placebos do and these are clearly surrogate placebos. Further, there is art involved in a provider’s planning and accomplishment of his continued medical education. “Is this course or lecture going to benefit my patients more than that course or discussion?” There is art involved in planning the efficient use of time or provider energy and the application of capital investments in maintenance of a scientically useful office infrastructure….and of course we need much skill and art in managing human resources in our offices.

To the extent that we use art in our practices, we cannt really use “quality” as a guage of value or worth or goodness. After all, we don’t wander through the Louvre saying that this painting has more quality than that painting. Quality is a rather meaningless term when applied to art.

This argument, note, is not saying that there are no facets of health care for which the term quality is inappropriate.

By: pjnelson

pjnelson — Tue, 06 Mar 2018 19:56:28 +0000

It is well to own rose colored spectacles when you haven’t worked on the front-lines of healthcare for 40 years. From my own perspective, a couple of observations are in order. We are the only developed/advanced world-wide nation with a worsening maternal mortality ratio now for 25 years in a row (see WHO/UNICEF report for 2015). Our nation’s longevity has now decreased for two years in a row.
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We spend more for healthcare than any other OECD nation as measured by the portion of our national economy allocated to health spending. All of the other 34 OECD nations allocate 13.1% of less of their economy to health spending. In 2016, our nation’s health spending represented 18.0% of the national economy. The difference in 2016 between 13.0% and 18.0% represented nearly $1 Trillion, the cost of fighting 10 Iraqi/Afghanistan Wars in 2005, SIMULTANEOUSLY.

In effect, our nation’s health spending has indirectly damaged our nation’s future. We now have achieved an inability to invest in our nation’s education and infrastructure without mounting further Federal deficit spending. Finally, there is no serious reason to believe that the cost and quality problems of our nation’s healthcare will be solved with our current strategy for healthcare reform. The alternatives exist, but the paradigm paralysis is profound.

To begin, we must understand the Power Law Distribution characteristics of our nation’s health spending. A sensible analysis would reveal that our nation’s health spending for 160 million citizens, with the lowest healthcare needs, is @$1000.00 annually. For the 3 million citizens, with the highest healthcare needs, the health spending is @$1,000,000.00 annually. To redirect these dimensions, two national priorities apply, First, we will need a community by community directed improvement in the equitable availability of Primary Healthcare (a community in this case would represent @ 400,000 citizens, as adjusted for population density). Secondly, we need a comprehensive risk management strategy as formally allocated among the four responsible national sectors: Government at all levels, Health Insurance at all levels, Providers at all levels, and citizens at all levels (single families, families with dependents, institutional citizens, non-citizens).