Saturday, April 30, 2011

The Difficult Politics of Health Care Reform

Earlier this week, wife Marilyn and I between us had three physician appointments on the same day. Both of us had lab work and I had a hormone injection.

In every case the services were provided in attractive, modern, well-equipped facilities. Personnel were professionally competent (so far as we could tell), courteous, and attentive. Each appointment was kept on time. The services were obtained at locations that were geographically convenient for us.

All services were covered by Medicare. Deductibles and co-pays were either covered by insurance or modest in amounts.

So it is hard to get us excited about reform. It is hard for us to think of anything that government might do that would make our health care better. On the other hand, we can imagine lots of things that would make it not as good.

It seems reasonable to assume that ours was, if not a universal experience, at least a common one.

So it is little wonder that health care reform, while necessary, is proving so difficult. Those responsible for making it happen need to develop strategies for dealing with the opinions of the large portion of the population, and the even larger portion of those who are politically active, who are happy with their care and don’t want it tampered with.

Sunday, April 03, 2011

The Amazing Tolerance for Non-Management in Health Care

Here we are, more than a decade into the twenty-first century and much farther than that into the information age and our system of delivering health care still can’t keep reliable track of what medications a patient is taking.

According to an article that appeared in the March 11, 2011 issue of H&HN, the journal of the American Hospital Association, “Unintended changes in medications occur in one-third of all patients transferred between hospital departments and in 14percent of patients at hospital discharge, according to the Agency for Healthcare Research and Quality.”

In any other line of work, such a record would be considered disgraceful and bordering on the scandalous. Yet with all the palavering and political maneuvering over health care reform, we hear nothing about the absence of management. To maintain consistency in a patient’s medication program may involve some operational complexity, but it is a simple thing to think about. Whoever in the health care delivery system is involved in prescribing a medication ought to know with almost 100percent certainty what drugs the patient is currently taking. With all the bright systems analysts and designers of computer applications that there are around, it ought to be possible in relatively short order to figure out ways of achieving such a goal.

But, of course, that would come to nothing unless someone was in a position to implement them. In other words, it would require some management.

Perhaps in due course, we will reach the point of expecting as much, even insisting on it. But, amazingly, we are not there yet.

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