Intro: Crisis by Design
Crisis
Bureaucracy, frustrated doctors, 40 million without health insurance
Barely 1/5 Americans think medical system
... [Show More] works well
government
Reform
In spite of good intentions, we accomplish far less in medical care than we should.
Political system makes it hard – parties and committees
o Many in favor of the status quo
Basic confusion about what reform would be the best, many contradictions
Gov’t and private insurers only cover 40% of medical spending
o Need cooperation from both sectors
What is so troubling about health care?
Cost – average of $5000 a person per year
Access- 20,000 people die each year because they are uninsured
Quality – hospital errors a leading cause of death, some get too much care
o We waste a lot of money on care that has little value.
o Not enough emphasis on prevention
o There are many treatable diseases, but for which rates of successful treatment are
low.
We value the new technology and medicine, but does that mean increases in medical costs
are worth it?
It seems obvious that medical care’s goal is to improve health. If it works well it justifies
cost, but controlling medical costs is a goal within itself.
o Evidence shows that spending more has been good.
We worry too much about wasting money on medicine.
o The issue is not how much we put in, but making sure we get our value.
Need to eliminate errors in the system, limit excessive care, and provide
more care when it is underprovided
Treatment overuse- physicians use even though lit says no
o Common denominator = reimbursement
Make payments dependent as much on the effectiveness of the service as on
the quantity and sophistication
Pay for performance
Good care earns more than poor care
Make sure we are healthy, not just “treated”
Downloaded by Simon Kamau ([email protected])
lOMoARcPSD|25111999
Chapter 1: The Health of the Nation – A History
Health is a slippery term.
Virgorous and happy life, but that changes over time
o Makes health measurement difficult
Easiest to measure is length of life (mortality, life expectancy)
Changes in the source of a longer life
o Mortality has declined over the course of the 20th century bc of public health and
nutritional improvements up to 1940, the development of antibiotics in the next
two decades, and medical technology to treat cardiovascular disease and low birth
weight infants especially since 1960.
medicalization of health (formal medicine now plays big role)
scale of our medical system
o $500 per person in 1950 $5,000
o accounts for approx. 15% of GDP
o doctors are no longer generalists – now have medical specialties
o lack of knowledge was the major factor limiting progress in health care
institutions that now promote medical advances, such as NIH
Quality of life is more difficult to measure.
Modern men are in better health than men a century ago (respiratory disease,
cardiovascular, joint and back problems)
Economic advance is one factor in this change.
o Manual labor, exposure to toxins, infectious disease
“failure of success”: medicine is sustaining people who have a very poor quality of life,
and for whom the benefits of a longer life are not great
research focuses on older population (ex: active retirement)
the very sick are getting sicker
o larger numbers of elderly with severe physical impairments
o BUT….
measures of health were relatively poor in these studies
increase in diagnosis, not necessarily disease
better data is needed!!!
there is no failure of success! There are more victories.
Mental health problems
More stresses in life, less cohesive families, weaker societies
Data on mental health of populations is hard to obtain
o Hard to measure disease trends when the measures of disease [Show Less]