Still Failure After All These Years

The following is a 2004 prediction specific to the year 2014 made by US Health Experts as captured by US News and World Report:

In 10 years, the increasing use of online medical resources will yield substantial improvement in many of the pervasive problems now facing healthcare—including rising healthcare costs, poor customer service, the high prevalence of medical mistakes, malpractice concerns, and lack of access to medical care for many Americans.

Ten Years After

By assumtion and belief backed by the creation of programs and expenditures, the US has actually helped to distract spending toward administrative costs and away from direct spending on those who deliver care - failing to meet increasing needs for workforce and services.

Experts failed to understand the limitations of various designs. Care management, even using the most promising designs, did not result in appreciable savings. The cost of doing the management often ate up any savings as investigated by the Congressional Budget Office.

In many ways the US has not improved since the 1970s - the year Still Crazy After All These Years was recorded by Paul Simon.

Insanity is attempting the same thing over and over expecting a different result.

I'd Love to Change the World

It seems that designers still don't know what to do. Of course one thing is different from the Ten Years After Song. We did not tax the rich and feed the poor although in some ways the rich did disappear since a few dozen individuals own so much of the world.

We lost the hard work and investment of 1965 to 1975 - investment that was specific to care delivery with money spent most directly upon the clinicians and teams to deliver the care. It seems easier to do something else other than to invest in the teams and clinicians that actually deliver the care. An alternative explanation is that other entities, facing a more stagnant US economy, decided to find their way into the health care pie.

And predictions by 2025 contain the same as for this year, even though we have made little progress. For example primary care workforce is not improving because spending specific to primary care is not improving and cost of delivery for primary care is increasing in ways that prevent the increases in team members and clinicians to deliver the care.

Reducing deficits of workforce is unlikely as the 2600 counties with lower to lowest concentrations of clinicians are growing the fastest in population, and are growing the fastest in the populations increasing most in care demand.We are also failing to produce the types of workforce specific to the needs of these 2600 counties (broadest generalists and general types of specialties).

Magical thinking must be replaced by nuts and bolts common sense for any real progress in health care. It takes people to deliver care to people. Technology can aid this delivery, but it can also get in the way. This is the great lesson of the past decade and recent decades also.

If you really want a blast from the past, check out this 1991 review of US health care by the Chairman of the AAMC of the time - William T Butler, MD, in his Academic Medicine's Season of Accountability and Social Responsibility. Butler reviewed these headlines of 23 years ago:

Newsweek: The Revolution in Medicine
Fortune: Taking on Public Enemy No.1
Business & Health: Physician, Cut Thy Costs
Nation’s Business: Curbing Costs of Health
The New York Times: Demands to Fix US Health Care Reach a Crescendo
The Houston Post: Church Leaders Decry Nation’s Health Care
US News and World Report: Doctor’s Dilemma: Treat or Let Die?
Business Week: Driving Down the Costs of an Aging America
Time: Scandal in the Laboratories
Newsweek: The Big Business of Medicine
The New York Times: Medical Technology Race Adds Billions to the Nation’s Bills
The Washington Post: Medical Care: How Much Health Care Can We Afford?
Newsweek: State of Emergency
Newsweek: Not Enough for All – Oregon Experiments with Rationing
The New York Times: Why Emergency Rooms are on the Critical List
Corpus Christi Caller: Doctors in Short Supply – Rural, Poor Areas Rely on State Incentives
American Medical News: Healing the Homeless
Newsweek: Can You Afford to Get Sick?

Butler's reforms are still ignored and his model medical education examples are still successful today but have not been widely replicated. Concentrating workforce as usual remains the design for health spending and health professional training.

Links

CBO Working Paper 2012-01 Lessons from Medicare's Demonstration Projects on Disease Management and Care Coordination

William T Butler, MD, in his Academic Medicine's Season of Accountability and Social Responsibility

Recent Blogs

Acting Upon Discrimination in Health Spending

Understanding Common Errors in Quality Studies

Real Reasons for Rotten Outcomes

Too Many and Still the Wrong Clinicians

The Government Control Card Still Plays Well

Rotten Apples, Rotten Support, or Rotten Media?

Improving Health Care is Not Likely for 2600 Counties

Global Fails Local But Local Focus Succeeds Globally

Domino Decline By Design - as ERs Close, Those Nearby Face Challenges, as Small or Rural Hospitals Close or Practices Where Needed...

Declines in Health Care Delivery Despite Increases in Health Spending - If We Keep Accelerating Non-Delivery Costs, We Can Continue to Remain Behind Health Care Demand


Blogs indicate that primary care can be recovered and should be recovered.

Dr. Bowman is the North American Co-Editor of Rural and Remote Health. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association and the long term chair of the STFM Group on Rural Health.


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