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Thread: Why healthcare needs to be fixed...

  1. #1
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    Why healthcare needs to be fixed...

    [B]VITAL SIGNS
    U.S. health system scores a D in new report card

    Low efficiency, plummeting access to care yield poor value, study finds

    By Kristen Gerencher, MarketWatch

    Last update: 7:35 p.m. EDT July 17, 2008SAN FRANCISCO (MarketWatch) -- Weighed down by a steep decline in access to medical care and poor efficiency, the overall performance of the U.S. health-care system dipped this year compared with a report from two years ago.
    The system scored 65 out of a possible 100 points, down slightly from a score of 67 in 2006, according to a new study from the Commonwealth Fund's Commission on a High Performance Health System. The scorecard, the second of its kind, evaluated 37 different indicators of healthy lives, quality, access, efficiency and equity and compared them with national and international benchmarks of achieved performance.

    "Overall, we find a failure to improve," said Cathy Schoen, senior vice president of the Commonwealth Fund, a private foundation in New York. "Yet national spending continues to rise each year, with the U.S. leading the world. We're on our way to spending one out of every five dollars on the health-care system. We should be expecting much better value in return."
    Better value is achievable, and improvements in key performance indicators could lead to 100,000 fewer premature deaths and save at least $100 billion annually, the authors argue.

    The report is likely to rekindle political debate about the best ways to remedy the problems. Both presidential candidates, Sens. Barack Obama and John McCain, have health-care proposals that call for elements of cost control and quality improvement, though they disagree markedly on how to broaden access to care.

    Efficiency remains low

    With a score of 53, efficiency measures were rated lowest of all the categories, nearly unchanged from the 2006 figure of 52. The U.S. did poorly on measures of avoidable hospitalizations, administrative costs and inappropriate, wasteful and fragmented care. There also was wide variation in quality and costs and little use of information technology.

    "This is a real wake-up call," said Paul Ginsburg, president of the Center for Studying Health System Change, a nonpartisan research group in Washington. "It's really telling us that because our delivery system is so fragmented [and] disorganized with the wrong payment incentives that our country is really suffering from that."

    Realigning incentives could make a big difference, he said. Last year, Medicare announced it will no longer reimburse hospitals for so-called never events, certain serious medical errors and preventable hospital-acquired conditions.

    The number of U.S. primary care physicians using electronic medical records increased to 28% in 2006 from 17% in 2001, but it still pales in comparison to the 98% of doctors who use them in the Netherlands and the 89% penetration rate in the U.K.

    Many U.S. doctors rely on data systems that are separate from other doctors and hospitals, increasing patients' dependence on a single provider and upping the likelihood that tests will be repeated unnecessarily, Ginsburg said.

    "Our incentives are to repeat the tests, make more money, whereas in other countries the tests are all done in the same delivery system," he said. "They're not going to be duplicated."

    Of all the categories evaluated in the scorecard, access to care took the greatest plunge, dropping to a score of 58 from 67 two years ago. In 2007, more than 75 million working-age adults, or 42% of all Americans between 19 and 64, were either uninsured during the year or underinsured, up from 35% in 2003, the study found. "This was before the recent slowdown in the economy," Schoen said.

    On a brighter note, the quality of hospital care for patients suffering a heart attack, heart failure or pneumonia improved as the median portion of those receiving recommended care for all three conditions rose to 90% in 2006 from 84% in 2004.

    Comparing the findings

    The scorecard showed the U.S. is failing to keep pace with other industrialized countries that have pushed ahead with health-care improvements. Specifically:

    The U.S. came in last out of 19 nations surveyed in the number of deaths that may have been avoided with the proper care in 2002-2003, falling from 15th place in 1997-98. This category measured a set of at least partially treatable or preventable conditions, such as the number of children who died of intestinal infections before age 15, the number of adults who succumbed to diabetes before age 50 and those who died of appendicitis before age 75. In the most recent figures, the U.S. had an average 110 preventable deaths per 100,000 population compared with 65 per 100,000 in France and 71 in Japan and Australia, the leading countries in this measure. Overall, the U.S. improved in reducing the number of deaths before age 75 caused by complications that could have been avoided with timely, appropriate care by about 4% since 1997-98, but other countries improved by an average of 16%, the study found.

    The U.S. has the highest share of national health expenditures spent on insurance administration, with 7.5% going to claims administration, underwriting, marketing, profits and other overhead. That's three times higher than in countries with the lowest rates. France spends 6.9% on administrative costs, with Germany shelling out 5.6% of its health-care expenses on administration. Switzerland's outlays come to 4.8%, the U.K. spends 3.3% and Japan 2.3%. The U.S. rate of spending on administrative costs reflects wide variation between public programs such as Medicare and Medicaid, whose administration costs run around 2% to 3%, and the 15% to 20% typical of private insurers, Schoen said. Large group private insurance is at the lower end of that spectrum while individual insurance, which is expensive to market and process, is on the high end. "We estimate we could save $50 billion a year if we could move to a system like Switzerland or Germany, which also have multipayer systems," Schoen said. Many countries with universal coverage are able to keep overhead costs down because they don't need to check up on insurance eligibility and manage constantly changing enrollment, she said. "They don't have churning. You tend to be covered when you're born. It's not part of market rules that you can turn me down if I'm sick."

    The number of sick Americans who sought care and found it was hard to get without resorting to the emergency room during nights, weekends or holidays climbed to 73% in 2007 from 61% in 2005, the study found. That compares with 48% of adults in the Netherlands who said so last year, 50% of Germans and 69% of Canadians.

    The problems weren't confined to the working-age population. Eighteen percent of Medicare beneficiaries had to be readmitted to a hospital within 30 days of being discharged for any of 31 different conditions such as gallbladder removal, the treatment of chest pain or diabetes. But the average hides "extraordinary variability" across regions, Schoen said. The highest readmission rate was 21% of previously hospitalized older patients while the lowest was 14%.

    Half of U.S. adults receive recommended preventive care and screenings such as annual flu shots, periodic cholesterol screenings, blood pressure checks and mammograms every two years for women age 40 and older. The compliance rate is higher for people insured all year -- 53% -- compared with those uninsured all year, only 32% of whom received the recommended preventive care for their age and sex. The more affluent also were more likely to avail themselves of recommended screenings than people with less income.

    Kristen Gerencher is a reporter for MarketWatch in San Francisco.[/B]
    Last edited by long island leprechaun; 07-17-2008 at 10:28 PM.

  2. #2
    Just some freindly feedback.....an entire article in italics is extrememly hard to read. So forgive me, but I didn't read your post.

    On a related note, I heard a radio report this morning of a Healthcare Co. who dumped expensive patiets "retroactively" after they became expensive. If the report is true, the people behind those decision should be held accoutable to the utmost of the Law. Sickeningly dishonest and horrid to do such a thing.

  3. #3
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    [QUOTE=Warfish;2633353]Just some freindly feedback.....an entire article in italics is extrememly hard to read. So forgive me, but I didn't read your post.

    On a related note, I heard a radio report this morning of a Healthcare Co. who dumped expensive patiets "retroactively" after they became expensive. If the report is true, the people behind those decision should be held accoutable to the utmost of the Law. Sickeningly dishonest and horrid to do such a thing.[/QUOTE]

    I switched it to bold print... now that should get your attention ;)

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    [QUOTE=long island leprechaun;2633364]I switched it to bold print... now that should get your attention ;)[/QUOTE]

    Not really an improvement.

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    [QUOTE=Warfish;2633353]On a related note, I heard a radio report this morning of a Healthcare Co. who dumped expensive patiets "retroactively" after they became expensive. If the report is true, the people behind those decision should be held accoutable to the utmost of the Law. Sickeningly dishonest and horrid to do such a thing.[/QUOTE]

    That's the "free" market, bro. Those sick people are useless to society and should be allowed to die off and be replaced by healthier members.

  6. #6
    [QUOTE=PlumberKhan;2633812]That's the "free" market, bro. Those sick people are useless to society and should be allowed to die off and be replaced by healthier members.[/QUOTE]

    Actually, no. It's not.

    When someone pays for a service/product, and then fails to receive that service/product "retroactively", i.e. when they were paid up for their coverage, that is fraud actually.

  7. #7
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    Pure BS

    Just another political statement
    by another Rich Peoples Philanthropy

    - hijacked by Carter/Clinton-era libtards

    - completely & throroughly misinterpreted by their sicko-phants

    a) the U.S. gets panned for "capacity to innovate and improve to achieve excellence" - although in the fine print this is supposed to apply to primary care and not research, does anyone really believe this nonsense?

    b) there's no comparative statement anywhere- ie how well
    do Americans survive illnesses vs other countries?

    c) they want new national policies etc etc....Hmm who is in favor of that pray tell

    well, you can see how they feel:

    [URL]http://www.commonwealthfund.org/General/General_show.htm?doc_id=670761[/URL]

  8. #8
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    .[QUOTE=long island leprechaun;2633347] VITAL SIGNS
    U.S. health system scores a D in new report card

    Low efficiency, plummeting access to care yield poor value, study finds

    By Kristen Gerencher, MarketWatch

    Last update: 7:35 p.m. EDT July 17, 2008SAN FRANCISCO (MarketWatch) -- Weighed down by a steep decline in access to medical care and poor efficiency, the overall performance of the U.S. health-care system dipped this year compared with a report from two years ago.
    The system scored 65 out of a possible 100 points, down slightly from a score of 67 in 2006, according to a new study from the Commonwealth Fund's Commission on a High Performance Health System. The scorecard, the second of its kind, evaluated 37 different indicators of healthy lives, quality, access, efficiency and equity and compared them with national and international benchmarks of achieved performance.

    [QUOTE=long island leprechaun;2633347]
    The number of U.S. primary care physicians using electronic medical records increased to 28% in 2006 from 17% in 2001, but it still pales in comparison to the 98% of doctors who use them in the Netherlands and the 89% penetration rate in the U.K. [/QUOTE]Do you know how expensive these EHR systems are? Especially to solo or small group practices that have employees to pay, malpractice premiums to pay. It costs $40,000 per doctor to set up, plus tens of thousands per year to maintain. That is the true reason why the US penetration rate is lower than those countries cited. [url]http://blogs.wsj.com/health/2008/06/18/costs-crimp-adoption-of-electronic-health-records/[/url]
    [QUOTE=long island leprechaun;2633347]
    Many U.S. doctors rely on data systems that are separate from other doctors and hospitals, increasing patients' dependence on a single provider and upping the likelihood that tests will be repeated unnecessarily, Ginsburg said.

    "Our incentives are to repeat the tests, make more money, whereas in other countries the tests are all done in the same delivery system," he said. "They're not going to be duplicated." [/QUOTE] Yes, the old doctor is out to make money line. Defensive medicine is an issue, but tort reform is the answer. That plus having a patient actually know what when and where they were tested before. Sounds simple, but in my experience many patients are clueless about prior testing.
    [QUOTE=long island leprechaun;2633347]
    Of all the categories evaluated in the scorecard, access to care took the greatest plunge, dropping to a score of 58 from 67 two years ago. In 2007, more than 75 million working-age adults, or 42% of all Americans between 19 and 64, were either uninsured during the year or underinsured, up from 35% in 2003, the study found. "This was before the recent slowdown in the economy," Schoen said. [/QUOTE]
    Sounds high to me. And what does this mean? Someone changed jobs and opted not to pay COBRA and take a chance? Was young and healthy and opted out of insurance? (have seen patients just like this, told a 24 year old healthy Wall Street kid that his skiing accident caused an ACL tear and he would need surgery. You think he regretted his choice then?)

    [QUOTE=long island leprechaun;2633347]
    On a brighter note, the quality of hospital care for patients suffering a heart attack, heart failure or pneumonia improved as the median portion of those receiving recommended care for all three conditions rose to 90% in 2006 from 84% in 2004.

    Comparing the findings

    The scorecard showed the U.S. is failing to keep pace with other industrialized countries that have pushed ahead with health-care improvements. Specifically:

    The U.S. came in last out of 19 nations surveyed in the number of deaths that may have been avoided with the proper care in 2002-2003, falling from 15th place in 1997-98. This category measured a set of at least partially treatable or preventable conditions, such as the number of children who died of intestinal infections before age 15, the number of adults who succumbed to diabetes before age 50 and those who died of appendicitis before age 75. In the most recent figures, the U.S. had an average 110 preventable deaths per 100,000 population compared with 65 per 100,000 in France and 71 in Japan and Australia, the leading countries in this measure. Overall, the U.S. improved in reducing the number of deaths before age 75 caused by complications that could have been avoided with timely, appropriate care by about 4% since 1997-98, but other countries improved by an average of 16%, the study found. [/QUOTE]
    Compliance and comorbidities are a large unaccounted part of the differences between the US and other countries.
    [QUOTE=long island leprechaun;2633347]
    The U.S. has the highest share of national health expenditures spent on insurance administration, with 7.5% going to claims administration, underwriting, marketing, profits and other overhead. That's three times higher than in countries with the lowest rates. France spends 6.9% on administrative costs, with Germany shelling out 5.6% of its health-care expenses on administration. Switzerland's outlays come to 4.8%, the U.K. spends 3.3% and Japan 2.3%. The U.S. rate of spending on administrative costs reflects wide variation between public programs such as Medicare and Medicaid, whose administration costs run around 2% to 3%, and the 15% to 20% typical of private insurers, Schoen said. Large group private insurance is at the lower end of that spectrum while individual insurance, which is expensive to market and process, is on the high end. "We estimate we could save $50 billion a year if we could move to a system like Switzerland or Germany, which also have multipayer systems," Schoen said. Many countries with universal coverage are able to keep overhead costs down because they don't need to check up on insurance eligibility and manage constantly changing enrollment, she said. "They don't have churning. You tend to be covered when you're born. It's not part of market rules that you can turn me down if I'm sick." [/QUOTE]
    10% of medical costs go to billing and collecting fees. What other industry has such a set-up? I'm all for fixing that.

    [QUOTE=long island leprechaun;2633347]
    The number of sick Americans who sought care and found it was hard to get without resorting to the emergency room during nights, weekends or holidays climbed to 73% in 2007 from 61% in 2005, the study found. That compares with 48% of adults in the Netherlands who said so last year, 50% of Germans and 69% of Canadians.[/QUOTE]
    Define "hard to get without resorting to the ER during nights, weekends, or holidays". Am I supposed to keep office hours at 2AM? What are "reasonable expectations"? Talking to someone on the phone at 2AM and giving advice is more than reasonable to me.
    [QUOTE=long island leprechaun;2633347]
    The problems weren't confined to the working-age population. Eighteen percent of Medicare beneficiaries had to be readmitted to a hospital within 30 days of being discharged for any of 31 different conditions such as gallbladder removal, the treatment of chest pain or diabetes. But the average hides "extraordinary variability" across regions, Schoen said. The highest readmission rate was 21% of previously hospitalized older patients while the lowest was 14%. [/QUOTE]
    Not sure how this reflects on the health care system. Older patients, especially those who have been in the hospital, have comorbidities that it is not surprising many would be quickly readmitted. In fact, as a doctor I would be quicker to readmit someone who was recently discharged rather than treat them as an outpatient, for a variety of reasons. This appears to be nothing more than using the data to fit an argument.
    [QUOTE=long island leprechaun;2633347]
    Half of U.S. adults receive recommended preventive care and screenings such as annual flu shots, periodic cholesterol screenings, blood pressure checks and mammograms every two years for women age 40 and older. The compliance rate is higher for people insured all year -- 53% -- compared with those uninsured all year, only 32% of whom received the recommended preventive care for their age and sex. The more affluent also were more likely to avail themselves of recommended screenings than people with less income. [/QUOTE]
    Patient non-compliance is a big issue. Even those with insurance have a high rate of non-compliance. This goes hand in hand with the prior point that there are higher numbers of deaths in US from potentially treatable conditions. The difference here is that the non-compliance is brushed aside as the root cause, and instead "the system" is blamed.

    Kristen Gerencher is a reporter for MarketWatch in San Francisco. [/QUOTE]

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    HDCent,

    I have to say, having worked for the VA System for many years, that it is in an example of a system that didn't work very well for a variety of reasons in the past having reinvented itself in some very positive ways. The VA has had fully electronic records since 1998, with access to patient records nationwide for any provider. Our records include complete image scanning and trend charting, as well as a range of reminders for clinical providers that keep important variables of health monitoring up-to-date. Of course, the VA is a federal system that is capable of engaging economies of scale, avoidance of redundant services in multi-hospital areas, such as NY, while targeting increased access to care which would, if compared to other countries' systems, fare very well. For a system that is very large, the VA does incredibly well on independent audits across the board... better than most private hospitals. We do have the benefit of excellent affiliations with university hospitals, which must be factored into the equation as well as by far the largest teaching facilities for all major disciplines, not to mention an enormous amount of research that has been generated. Given that the VA works with many patients who simply couldn't get healthcare in private settings due to socio-economics and lack of insurance, we are not exactly dealing on an a level playing field with the private sector. Having personally seen examples of voluntary hospitals dumping patients into the city hospital system because they couldn't pay is not terribly uncommon. That's one of the sad features of our current system.

    Now I'm not advocating for an expansion of the VA to become a national health provider, but I do think the VA offers a useful model of what can be done with consolidation and centralization of care planning. As hospitals consolidate and merge, the little guys will have a more difficult time. The cost of technology alone will make Mom&Pop medicine a brutal bottom-line affair...

  10. #10
    How's the health care in Canada?

  11. #11
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    [QUOTE=SanAntonio_JetFan;2634242]How's the health care in Canada?[/QUOTE]


    Better question: how's the healthcare in France? They're the world leader among industrialized nations on most surveys.

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    [QUOTE=Warfish;2633837]When someone pays for a service/product, and then fails to receive that service/product "retroactively", that is fraud actually.[/QUOTE]

    Listen...IndyMac said they would have your money on Tuesday. Just relax...

    They gotta go get it from China...yo.

  13. #13
    [QUOTE=long island leprechaun;2633347][B]VITAL SIGNS
    U.S. health system scores a D in new report card

    Low efficiency, plummeting access to care yield poor value, study finds

    By Kristen Gerencher, MarketWatch

    Last update: 7:35 p.m. EDT July 17, 2008SAN FRANCISCO (MarketWatch) -- Weighed down by a steep decline in access to medical care and poor efficiency, the overall performance of the U.S. health-care system dipped this year compared with a report from two years ago.
    The system scored 65 out of a possible 100 points, down slightly from a score of 67 in 2006, according to a new study from the Commonwealth Fund's Commission on a High Performance Health System. The scorecard, the second of its kind, evaluated 37 different indicators of healthy lives, quality, access, efficiency and equity and compared them with national and international benchmarks of achieved performance.

    "Overall, we find a failure to improve," said Cathy Schoen, senior vice president of the Commonwealth Fund, a private foundation in New York. "Yet national spending continues to rise each year, with the U.S. leading the world. We're on our way to spending one out of every five dollars on the health-care system. We should be expecting much better value in return."
    Better value is achievable, and improvements in key performance indicators could lead to 100,000 fewer premature deaths and save at least $100 billion annually, the authors argue.

    The report is likely to rekindle political debate about the best ways to remedy the problems. Both presidential candidates, Sens. Barack Obama and John McCain, have health-care proposals that call for elements of cost control and quality improvement, though they disagree markedly on how to broaden access to care.

    Efficiency remains low

    With a score of 53, efficiency measures were rated lowest of all the categories, nearly unchanged from the 2006 figure of 52. The U.S. did poorly on measures of avoidable hospitalizations, administrative costs and inappropriate, wasteful and fragmented care. There also was wide variation in quality and costs and little use of information technology.

    "This is a real wake-up call," said Paul Ginsburg, president of the Center for Studying Health System Change, a nonpartisan research group in Washington. "It's really telling us that because our delivery system is so fragmented [and] disorganized with the wrong payment incentives that our country is really suffering from that."

    Realigning incentives could make a big difference, he said. Last year, Medicare announced it will no longer reimburse hospitals for so-called never events, certain serious medical errors and preventable hospital-acquired conditions.

    The number of U.S. primary care physicians using electronic medical records increased to 28% in 2006 from 17% in 2001, but it still pales in comparison to the 98% of doctors who use them in the Netherlands and the 89% penetration rate in the U.K.

    Many U.S. doctors rely on data systems that are separate from other doctors and hospitals, increasing patients' dependence on a single provider and upping the likelihood that tests will be repeated unnecessarily, Ginsburg said.

    "Our incentives are to repeat the tests, make more money, whereas in other countries the tests are all done in the same delivery system," he said. "They're not going to be duplicated."

    Of all the categories evaluated in the scorecard, access to care took the greatest plunge, dropping to a score of 58 from 67 two years ago. In 2007, more than 75 million working-age adults, or 42% of all Americans between 19 and 64, were either uninsured during the year or underinsured, up from 35% in 2003, the study found. "This was before the recent slowdown in the economy," Schoen said.

    On a brighter note, the quality of hospital care for patients suffering a heart attack, heart failure or pneumonia improved as the median portion of those receiving recommended care for all three conditions rose to 90% in 2006 from 84% in 2004.

    Comparing the findings

    The scorecard showed the U.S. is failing to keep pace with other industrialized countries that have pushed ahead with health-care improvements. Specifically:

    The U.S. came in last out of 19 nations surveyed in the number of deaths that may have been avoided with the proper care in 2002-2003, falling from 15th place in 1997-98. This category measured a set of at least partially treatable or preventable conditions, such as the number of children who died of intestinal infections before age 15, the number of adults who succumbed to diabetes before age 50 and those who died of appendicitis before age 75. In the most recent figures, the U.S. had an average 110 preventable deaths per 100,000 population compared with 65 per 100,000 in France and 71 in Japan and Australia, the leading countries in this measure. Overall, the U.S. improved in reducing the number of deaths before age 75 caused by complications that could have been avoided with timely, appropriate care by about 4% since 1997-98, but other countries improved by an average of 16%, the study found.

    The U.S. has the highest share of national health expenditures spent on insurance administration, with 7.5% going to claims administration, underwriting, marketing, profits and other overhead. That's three times higher than in countries with the lowest rates. France spends 6.9% on administrative costs, with Germany shelling out 5.6% of its health-care expenses on administration. Switzerland's outlays come to 4.8%, the U.K. spends 3.3% and Japan 2.3%. The U.S. rate of spending on administrative costs reflects wide variation between public programs such as Medicare and Medicaid, whose administration costs run around 2% to 3%, and the 15% to 20% typical of private insurers, Schoen said. Large group private insurance is at the lower end of that spectrum while individual insurance, which is expensive to market and process, is on the high end. "We estimate we could save $50 billion a year if we could move to a system like Switzerland or Germany, which also have multipayer systems," Schoen said. Many countries with universal coverage are able to keep overhead costs down because they don't need to check up on insurance eligibility and manage constantly changing enrollment, she said. "They don't have churning. You tend to be covered when you're born. It's not part of market rules that you can turn me down if I'm sick."

    The number of sick Americans who sought care and found it was hard to get without resorting to the emergency room during nights, weekends or holidays climbed to 73% in 2007 from 61% in 2005, the study found. That compares with 48% of adults in the Netherlands who said so last year, 50% of Germans and 69% of Canadians.

    The problems weren't confined to the working-age population. Eighteen percent of Medicare beneficiaries had to be readmitted to a hospital within 30 days of being discharged for any of 31 different conditions such as gallbladder removal, the treatment of chest pain or diabetes. But the average hides "extraordinary variability" across regions, Schoen said. The highest readmission rate was 21% of previously hospitalized older patients while the lowest was 14%.

    Half of U.S. adults receive recommended preventive care and screenings such as annual flu shots, periodic cholesterol screenings, blood pressure checks and mammograms every two years for women age 40 and older. The compliance rate is higher for people insured all year -- 53% -- compared with those uninsured all year, only 32% of whom received the recommended preventive care for their age and sex. The more affluent also were more likely to avail themselves of recommended screenings than people with less income.

    Kristen Gerencher is a reporter for MarketWatch in San Francisco.[/B][/QUOTE]yeah,america sucks.

  14. #14
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    [QUOTE=2foolish197;2634802]yeah,america sucks.[/QUOTE]

    When it comes to efficient use of what we spend as a nation on healthcare, yes, America pretty much sucks. We're not much different than a second-from-the-bottom baseball team with a couple of guys leading the league in some nice stats that don't translate into wins. You can be like the fan who focuses on the nice job these couple of guys are doing. For me, winning games is what matters. Being a leader in healthcare delivery to our citizens is what matters. But keep drinking the fifth grade Kool-aid and don't forget to attend your evangelical church on Sunday. :rolleyes:

  15. #15
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    [QUOTE=long island leprechaun;2634230]HDCent,

    I have to say, having worked for the VA System for many years, that it is in an example of a system that didn't work very well for a variety of reasons in the past having reinvented itself in some very positive ways. The VA has had fully electronic records since 1998, with access to patient records nationwide for any provider. Our records include complete image scanning and trend charting, as well as a range of reminders for clinical providers that keep important variables of health monitoring up-to-date. Of course, the VA is a federal system that is capable of engaging economies of scale, avoidance of redundant services in multi-hospital areas, such as NY, while targeting increased access to care which would, if compared to other countries' systems, fare very well. For a system that is very large, the VA does incredibly well on independent audits across the board... better than most private hospitals. We do have the benefit of excellent affiliations with university hospitals, which must be factored into the equation as well as by far the largest teaching facilities for all major disciplines, not to mention an enormous amount of research that has been generated. Given that the VA works with many patients who simply couldn't get healthcare in private settings due to socio-economics and lack of insurance, we are not exactly dealing on an a level playing field with the private sector. Having personally seen examples of voluntary hospitals dumping patients into the city hospital system because they couldn't pay is not terribly uncommon. That's one of the sad features of our current system.

    Now I'm not advocating for an expansion of the VA to become a national health provider, but I do think the VA offers a useful model of what can be done with consolidation and centralization of care planning. As hospitals consolidate and merge, the little guys will have a more difficult time. The cost of technology alone will make Mom&Pop medicine a brutal bottom-line affair...[/QUOTE]
    The VA has government funding- thus can get electronic records paid for. Not so easy in the private sector. Also, liability is not a concern in the VA- there is protection from lawsuits under the umbrella of the federal government. Therefore, defensive medicine and excessive testing may not be as big an issue.
    Then there is the problem of interfacing VA care with private care. I have many patients who also go to a "VA doctor" to get cheaper prescriptions. Makes it confusing for me in the non-VA world. The electronic records may work well for someone entirely within the VA system, but not if they are using both VA and non-VA services.
    It does seem though that the VAhas made great strides since my med school rotations in the early 1990's. However, the VA has several advantages as outlined that are not present in the private sector.
    Are you at Northport?

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    [QUOTE=HDCentStOhio;2634884]The VA has government funding- thus can get electronic records paid for. Not so easy in the private sector. Also, liability is not a concern in the VA- there is protection from lawsuits under the umbrella of the federal government. Therefore, defensive medicine and excessive testing may not be as big an issue.
    Then there is the problem of interfacing VA care with private care. I have many patients who also go to a "VA doctor" to get cheaper prescriptions. Makes it confusing for me in the non-VA world. The electronic records may work well for someone entirely within the VA system, but not if they are using both VA and non-VA services.
    It does seem though that the VAhas made great strides since my med school rotations in the early 1990's. However, the VA has several advantages as outlined that are not present in the private sector.
    Are you at Northport?[/QUOTE]

    I'm in New York (Harbor Health Care System). But you seem to be making the case for why nationalized health care would be in many ways more efficient... lawsuit protection, economies of scale re technology, cheaper prescription costs (much cheaper). By the way, we do have the capacity to scan in records and images from private physicians, as well as documents like advance directives. We have indeed made strides...

  17. #17
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    Join Date
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    Location
    NJ
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    2,393
    When libs say they want to "fix" healthcare, it's the same kind of fixing that your local vet does to a stray cat or dog.

    The US healthcare system is THE best in the world. Nothing in life is perfect and NOTHING is free. Medical costs would be cheaper if we could cut down the frivolous lawsuits.

    This story is just more peddled BS from the mainstream media...
    Last edited by Spirit of Weeb; 07-18-2008 at 09:02 PM.

  18. #18
    [QUOTE=long island leprechaun;2634903]I'm in New York (Harbor Health Care System). But you seem to be making the case for why nationalized health care would be in many ways more efficient... lawsuit protection, economies of scale re technology, cheaper prescription costs (much cheaper). By the way, we do have the capacity to scan in records and images from private physicians, as well as documents like advance directives. We have indeed made strides...[/QUOTE]is that your picture?

  19. #19
    [QUOTE=long island leprechaun;2634835]When it comes to efficient use of what we spend as a nation on healthcare, yes, America pretty much sucks. We're not much different than a second-from-the-bottom baseball team with a couple of guys leading the league in some nice stats that don't translate into wins. You can be like the fan who focuses on the nice job these couple of guys are doing. For me, winning games is what matters. Being a leader in healthcare delivery to our citizens is what matters. But keep drinking the fifth grade Kool-aid and don't forget to attend your evangelical church on Sunday. :rolleyes:[/QUOTE]a little harsh with the kool-aid line don't you think?

  20. #20
    All Pro
    Join Date
    Jan 2006
    Location
    greenwich village, NYC
    Posts
    8,169
    [QUOTE=Spirit of Weeb;2635002]When libs say they want to "fix" healthcare, it's the same kind of fixing that your local vet does to a stray cat or dog.

    The US healthcare system is THE best in the world. Nothing in life is perfect and NOTHING is free. Medical costs would be cheaper if we could cut down the frivolous lawsuits.

    This story is just more peddled BS from the mainstream media...[/QUOTE]

    Do you actually work in healthcare? Or are you the usual fool who has nothing to compare against and actually believes that whatever he gets is the best of all possible worlds?

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