Friday, July 15, 2011

A Series of Observations

In the process of catching up on my reading, I came across an article by James Douglas, a former governor or Vermont (Modern Healthcare, May 23 2011). Douglas was chairman of the National Governor’s Association in 2009. He opens the article by relating his decision to focus during his chairmanship on “Improving our system of delivering healthcare to the American people.” The concern expressed by Douglas was “that the rapidly rising cost of health care was outstripping the ability of the states to afford it.”

A report prepared for the NGA by the Commonwealth Fund suggested five areas for state-based reform.

I found the list intriguing, partly for its contents, but also for what was left out – thus speaking to the reasons why the cost issue is proving so difficult.

It led me to think about doing something I’ve never done before, which is to do a series of postings on a particular theme, one on each of the five suggestions.

Here is the first one:

“Quality Improvement. Ultimately, this is what it’s all about. We need to ensure that all Americans get the care they need when they need it. A study concluded that one doctor in six ordered a test that had already been done and one in four provided treatment that was unnecessary. We need to define quality, measure it, provide the IT support to assure its delivery, and pay for it appropriately.”

All of that is well and good, but it doesn’t address the cost problem and doing all the suggested things won’t by themselves improve quality. Only the providers can do that.

Douglas and others like him are clearly reluctant to address the issues of provider organization, behavior, and performance. But until they do, nothing much is likely to happen.

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