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Fixin' Healthcare

Tuesday, December 19, 2006

The Lifestyle Chronicles - Trying To Do Good And Achieving Less

The Center for Medicare and Medicaid Services (CMS) is trying to do good by establishing quality standards and protocols for medical care. Although their effort is not getting the expected results, the issue may be a turning point that could transform health care. Transforming health care is likely to be more productive than reforming medical care.

The predominant form of medical care in America is the diagnosis, treatment and follow-up care of individual patients with illness and disease. The increasing capability of the medical care system has been matched by an increasing incidence of chronic diseases, which are not cured by treatment. It is a situation characterized by greater inputs yielding diminishing returns. The CMS project has inadvertently demonstrated that point.

A recent report from Harvard University and the University of California San Francisco identifies health disparities between population groups within the United States. The report serves to illustrate the current health situation and how much needs to be done to improve health status.

The US population was divided into eight groups based upon race, location of the county of residence, population density, race-specific county-level per capita income and cumulative homicide rate. Assessments were made concerning life expectancy, the risk of mortality from specific diseases, health insurance and health care utilization for the eight groups.

The gap between the highest and the lowest life expectancies for the race-county combinations in the US is over 35 years. The mortalitiy disparities are most concentrated in young and middle aged males and females, and are the result of a number of injuries and chronic diseases with well-established risk factors. Between 1982 and 2001, the ordering of the life expectancy among the eight groups and the absolute difference between the advantaged and disadvantaged groups remained largely unchanged.

This means that millions of Americans identified by their sociodemographic characteristics and place of residence have life expectancies that are similar to some low-income developing countries. And, the situation is not getting any better.

Self-reported health plan coverage was lowest for western Native Americans and low-income southern rural blacks. However, crude self-reported health-care utilization was slightly higher for the more disadvantaged populations. The available data suggest that the variation in health plan coverage across the eight groups is small relative to the very large gradient in health outcomes.

The observed disparities in life expectancy cannot be explained by race, income, or basic health-care access and utilization alone. The authors conclude that health disparities will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries.

That, good people, is health and health care in the real world. It may be the explanation as to why qualitiy measures of medical care to distinguish between hospitals does not reveal a significance difference in deaths between high and low rated hospitals. Something more powerful than medical care is at work. Changing the course of the Titanic would have avoided the iceberg; rearranging the chairs on the deck would not.

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