U.S. health care system ranks last, lags behind developed nations

 It seems the American Medical Association has developed the worst health care system among industrialized nations.

U.S. health care system ranks last, lags behind developed nations

By Anne Francis, Tech Times | June 17,2014

Though it is the most expensive in the world, the U.S. healthcare system ranks lowest in quality and efficiency according to a new report.

The 2014 Commonwealth Fund survey found that the United States ranks lowest when it comes to quality and efficiency of healthcare systems among 11 industrialized countries.

The healthcare system of the United States has been a topic of heated debate in the last decade but its performance has always remained consistent, ranking worst among industrialized countries for the fifth time. It was also the case in 2004, 2006, 2007 and 2010. The United Kingdom was ranked as the best while Switzerland followed closely behind. The researchers also studied Australia, France, Canada, the Netherlands, Germany, Norway, New Zealand and Sweden.
The report said the United States spent $8,508 on healthcare per person in 2011 but the United Kingdom only spent $3,406 per person even as it ranked higher in providing quality and safe healthcare than the U.S. All other 10 nations spend a lot less than the U.S. healthcare per person and as a gross domestic product but still achieved better quality.
The United States offers the most expensive healthcare system but being the worst in quality among its 11 peer countries, people questioned whether or not Obamacare will help improve things. Based on the analysis, the U.S. healthcare system is poor on various measures such as preventable deaths and infant mortality because one-third of Americans reported skipping tests or treatment because of its high costs. The country got poor scores on healthy life expectancy at 60 years of age.
The U.S. was third in preventive care and providing tests and treatments for chronically ill patients. However, it got poor scores on primary care physicians' prompt attention and access to needed services.  It was lowest in equity, outcomes and efficiency. People reported that the high insurance expenditure is not commensurate to patient satisfaction or service quality. The U.S. healthcare system has high coverage gaps and personal costs which undermine the U.S. government's efforts to improve it.
"Disparities in access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home," the report said. It suggests a need for equity across the country because the lack of universal healthcare is a key difference between the United States and other industrialized nations.
The Affordable Care Act increases the number of Americans with improved access to care and further encourages the efficient delivery and organization of healthcare and investment in population health and important preventive measures.

Consumers have "no meaningful information about the quality of care," but the same can't be said for Leslie Michelson

Why do consumers have "no meaningful information about the quality of care"? Because businesses are the ones buying the insurance, not the patients. And insurers have no stake in long-term results.

September 21, 2012
Leslie Michelson: Doctor to the 1% (and Maybe Someday to You)
By JOSEPH RAGO
Wall Street Journal

The rich are different than you and me. Not only—yes, yes—do they have more money, but they've also heard of, and many have hired, Leslie Michelson.

...So the health-care delivery system, to the extent it qualifies as a system, "has no quality control, no integration, no coordination." Doctors "tend to operate in an independent and isolated way, and even specialists who've been treating the same patient for years and years typically never, ever speak to one another."

Private Health is designed to backfill these gaps whenever one of its patients has a medical emergency or complex condition, say, a traumatic brain injury or newly diagnosed cancer. A personal-care team parachutes in, led by a clinician employed by the company, and compiles a brief on the patient. They centralize and digitize the patient's medical records, usually dog-eared paper piles that can run to thousands of pages. Research scientists immerse themselves in the latest findings and treatment regimens for the particular condition involved.

Tests are double-checked—biopsy tissues are sent to an outside pathologist, MRIs to another radiologist. For an era of targeted therapies, Private Health runs a full battery of molecular diagnostics "to sequence the entire three billion base pairs of somebody's DNA in a couple of hours," Mr. Michelson marvels.

The goal is to ensure an accurate diagnosis and lay out all the treatment options. Private Health functions as a kind of running, independent second opinion. It operates in the twilight zone where there isn't a "best practice" for when and how to treat, but a continuum of risks and benefits that vary from patient to patient.

The clinician helps locate the right experts, Mr. Michelson says, and then works to "fuse together all these multiple specialists in a single team with a single objective." There are "no redos, no lost scans, no ambling around going from specialist to specialist, trying to figure out what's going on." The most frequent reaction is: "This is how medicine was always supposed to be practiced."

The idea for Private Health came to Mr. Michelson when he was running the Prostate Cancer Foundation, the multibillion-dollar philanthropy Michael Milken set up in 1993. Prostate cancer is a common disease but treatment isn't straightforward. Surgeons end up recommending surgery, radiation specialists radiation, still others "watchful waiting," etc.

Mr. Michelson says people started asking him for advice, which led to the prototype for Private Health. Eventually he decided to improve his process across more diseases and help more people.

One irony is that for all its white-glove extras (a research department, genetic profiling), a lot of what Private Health does are core functions that patients would value and providers or insurers ought to be doing but rarely do (case management, using computers). Why is that?

Cost is part of it. "It's too expensive for us to do it for everybody right now," Mr. Michelson says. Another part, he thinks, is that "the incentives are attenuated because of the structure of insurance," namely, job-based coverage.

Since businesses are the customers, not the individuals who change jobs every three years on average, insurers "act rationally" and don't invest in services with "short-term costs and long-term payback." Mr. Michelson thinks the better option is for businesses to convert to cash vouchers so their workers can buy portable policies. Right now, there is "no meaningful information about the quality of care, virtually no information about price, and no sensitivity to price," but that would change if the insurance industry built "an enduring relationship with consumers," he says.

"I understand that it is woven into the fabric of our society that employers can and should continue to pay for health insurance for their employees," Mr. Michelson declares. "But why, circa 2012, should HR departments be selecting and administering one or two or three plans for a thousand or a hundred thousand workers and their dependents? You don't need a Ph.D. in economics to understand that you will guarantee suboptimization."

Kaiser Permanente has processes "when issues related to quality of care arise"

"Every Kaiser Permanente physician is subject to review and evaluation to ensure the quality of care they provide. Like all health plans and hospitals in California, Kaiser Foundation Hospital Fresno has processes in place to monitor and evaluate the quality of care. And when issues related to quality of care arise, we have processes to take appropriate action."

In my case, Kaiser instituted a quality review on August 9, 2011. Then it cancelled the review on August 16, 2011.

Sure, Kaiser has processes. That statement is true. But Kaiser Permanente does not use those processes in a reasonable manner. It does not take appropriate action; that implication in the article below is false.


Our Point of View
Kaiser Permanente
October 16, 2007
Response to Los Angeles Times' Article About Fresno Medical Center

A recent story in the Los Angeles Times raised concerns about patient care involving a perinatologist on the professional staff at Kaiser Foundation Hospital Fresno. We take these issues very seriously. In regard to the Fresno Hospital matter, we took action more than two years ago to significantly limit the practice of the perinatologist and to monitor the care he delivers, and reported him to the state medical board.

Kaiser Permanente has more than 11,000 highly qualified physicians and specialists serving the needs of more than 6 million members in California. We expect each of them to provide the highest levels of quality care and believe in their clinical excellence.

Every Kaiser Permanente physician is subject to review and evaluation to ensure the quality of care they provide. Like all health plans and hospitals in California, Kaiser Foundation Hospital Fresno has processes in place to monitor and evaluate the quality of care. And when issues related to quality of care arise, we have processes to take appropriate action...