Friday, June 20, 2008

More on Culture and Reform

Yesterday’s Boston Globe reported that Massachusetts Medicaid and Massachusetts Blue Cross Blue Shield will stop paying doctors and hospitals for care and treatment resulting from medical errors.

This decision seems so logical that it is easy to overlook how remarkable it is. During almost all of the 80 years since the invention of health insurance, we have believed that doctors did the best they could but sometimes things turned out badly. We weren’t convinced of that by any objective evidence. It was just something that seemed to explain the way things were and so we believed it.

With the notable exception of the malpractice courts, we haven’t believed that hospitals were responsible for bad outcomes, either. Try to think of a case in which a board of trustees and a CEO were publicly criticized for a medical mishap occurring in their hospital.

Then in 1999, the Institute of Medicine (IOM) reported that tens of thousands of people were dying every year as a result of preventable medical errors. That conclusion was supposedly based on objective evidence, but the credibility of IOM was such that few were interested in examining it critically. Also, I suspect that by that time a goodly number of people had known personally of bad outcomes that they suspected were avoidable.

So our beliefs changed and as a result Massachusetts insurers are able without apparent objection to reach a decision that a few years ago would have raised a storm of protest. No positioning by politicians or legislative debates were required.

This should teach us the importance of the relationship between culture and health care reform.

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