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Wednesday, May 31, 2006

Culture and Health Care Reform

The issue of medical safety provides a clear illustration of the important bearing that cultural forces have on health care reform.

Not so long ago, it was generally believed that doctors did the best they could but there were no guarantees and sometimes things came out badly. Only in the most extreme circumstances would it be thought that an unfortunate outcome was somebody’s fault.

That is changing. Ever so slowly, perhaps, but then cultures seldom change rapidly.

One recent bit of evidence was the recent report that CMS, the federal Medicare agency, is considering the possibility of not paying in the case of what are called “never events” (Modern Healthcare, May 22, 2006).

A “never event” is something that should never happen. One example is wrong-site surgery; for example, doing rotator cuff surgery on the wrong shoulder. It doesn’t happen so often, but it isn’t rare, either. According to the Modern Healthcare report, the Joint Commission on Accreditation of Healthcare Organizations last year received reports of 84 wrong-site surgeries.

Anyone not familiar with American medical culture might well wonder why anybody should pay for surgery done at the wrong site. But that is exactly what Medicare (like most insurance plans) is doing. Furthermore, when wrong-site surgery causes further damage that needs repair, Medicare pays for that, too.

Robert Wachter, chief of the medical service at the University of California at San Francisco Medical Center, was quoted as saying that not paying for never events would be “a very large and bold step.”

In a way, he is right about that. Any step that changes the culture qualifies as “large and bold.”

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