Basic Health Access

What is must important for health care leaders, designers, and researchers to understand is their limitations. Leaders have chosen the designs and research that they like without understanding the limitations and defects of the research. My vote for what has most set the US behind in health care goes to the tyranny of the aggregate.  Once again, Dr. Saurabh Jha comes to the rescue by nailing this tyranny the best. "What is the central tendency of a distribution but a lazy generalization? The aggregate, the mean, is wrong about everyone but the few closest to the mean, yet is so revered because we mistake the aggregate for the truth. The tyranny of the aggregate is the most extraordinary tyranny of our times. The aggregate is built by people who vary, yet it imposes itself on the individuals, the very variation which creates it. It literally bites the hands that feed it."   SAURABH JHA, MD (associate editor with The Health Care Blog) This is likely the mos...

In 1983 after a very short period of testing on a very atypical state (New Jersey) and because there were no other existing options for cost cutting, the hospital payment method known as DRG or Diagnosis Related Groups was implemented. Bundling under a disease or condition or treatment remains a very popular method of cutting costs and is now being implemented with physician payments. What are the benefits and what are the consequences? Should we implement methods that have long term consequences when we fail to consider or study these issues? If there is any consolation for President Obama and CMS,  ...it may well be that Readmission Penalties took away some of the "poor quality" result of the Bundling Bungling that preceded it (DRGs). This may be the only evidence for Accountable Care working. Of course Readmissions focus has consequences also. Is the Change in Readmission Rates an Indication of Poor Quality from DRGs? This is an interesting question. As noted pre...

The folly of "quality studies" is the quality. One would think that there would be quality in studies published in the most prestigious journals or reported by the Institutes of Medicine. But you should be skeptical of any claim regarding quality. This is a basic requirement to understand what quality is and what it is not in application to health care.  The media constantly turns to the latest quality health care studies to attract attention and readership. Some are good reviews. Others do bashing of doctors, or certain types of providers. Some articles promote their favorites such as nurse practitioners or various innovations.  What stimulated my attention this time is July is a Dangerous Hospital Month on Vox . After the BMJ article about medical errors, it is likely that we will continue to see more in this area. Doctor bashing has become quite popular, especially when journalists experience health care in certain ways. What journalists and even quality experts t...