Health Care - General
- Jul 28, 2006 - comment
“People use health care services for many reasons: to treat illnesses, injuries, and health conditions; to prevent or delay future health care problems; to reduce pain and increase quality of life; and to obtain information about their health status and prognoses. The study of trends in health care utilization provides important information on these phenomena and spotlights areas that warrant further study. Utilization trends may also be used to project future health care needs and expenditures, as well as training and supply needs.
“Admissions to hospitals and length of stay declined substantially in the 1980s and 1990s, but these declines appear to be leveling off . . . The diagnoses recorded on inpatient hospital stays are changing, as are the procedures performed on inpatients . . . Hospitalizations for procedures that can be performed on an outpatient basis, such as lens extractions and knee arthroscopies, have all but disappeared from inpatient settings. Instead, inpatient care is becoming more intensive and complex, with more procedures such as insertions of cardiac stents and hip replacements being performed, particularly on older persons . . . In addition to changes in the location of services, the types of services being provided have changed. In particular, the number of drugs prescribed or administered during visits to physicians and hospital outpatient departments is increasing.
Health, United States, 2005 (Centers for Disease Control and Prevention), 4. [Accessed February 17, 2006]
“The latest annual Gallup Poll on health finds a modest drop in the percentage of Americans giving a high rating to the quality and coverage of healthcare in this country, as well as a significant increase in the percentage of Americans favoring a government healthcare system. Overall, Americans continue to rate healthcare quality much higher than healthcare coverage, and to rate their own healthcare more positively than what the general public receives . . . The poll, conducted Nov. 7-10, finds Americans somewhat more positive than negative about the overall quality of healthcare in the country. By a margin of 53 percent to 47 percent, Americans say U.S. healthcare quality is excellent or good, rather than fair or poor. Those figures are down from a 59 percent to 40 percent rating last year and a 60 percent to 40 percent rating in 2003. The current figures are in line with what Gallup measured in 2001 and 2002 . . . Perceptions of healthcare coverage in the United States, which have been more negative than positive since Gallup first asked the question in 2001, have fallen to their lowest point in the last five years. Just 21 percent give an excellent or good rating to U.S. healthcare coverage, while 78 percent rate it as only fair (43 percent) or poor (35 percent). In the previous four years, excellent/good ratings ranged between 28 percent and 30 percent.”
David W. Moore and Jeffrey M. Jones, U.S. Healthcare Ratings Slip (Gallup Poll), December 7, 2005 [Subscription required]
“The American health care system provides excellent care to many of its patients much of the time, but, on the evidence, not to enough of its patients enough of the time. As a series of landmark reports from the Institute of Medicine has documented, there is in our health care system what the Institute terms a ‘quality chasm’—a wide gulf between the care that patients should receive and the care that is actually delivered.
“Despite the heightened attention and effort devoted to improving the quality of care in recent years, that chasm endures . . . A major new RAND study makes clear just how vast those gaps remain. Researchers examined the medical records of random samples of thousands of patients across twelve metropolitan areas and evaluated the care that these patients received over a two-year period. Using 439 indicators of quality developed by multi-specialty expert panels, the analysts found that participants in the study received only 54.9 percent of recommended care—a proportion that varied little across the categories of preventive, acute, and chronic care.
“Mismatches of this magnitude between ideal and actual practices would not be tolerated in most industries. Why are they permitted to persist in health care, where they cost lives and produce pain and suffering?
“The Institute of Medicine has estimated that between 44,000 and 98,000 Americans die each year from preventable medical errors in hospitals. That range of projections does not include the 88,000 deaths that, according to the Centers for Disease Control and Prevention, occur because of infections contracted during hospitalization, nor, obviously, does it include deaths due to preventable medical errors in settings other than hospitals. Dr. David Lawrence, the former chairman and chief executive officer of Kaiser Permanente, has calculated that mistakes in the use of medical technologies, across all settings of care, account for at least 400,000 deaths each year, of which about two-thirds can be attributed to preventable ‘health care accidents.’”
Excerpted from Building a Better Health Care System (National Coalition on Health Care), July 20, 2004 [Accessed February 21, 2006]
- “Infections contracted in hospitals are the fourth largest killer in the United States, causing as many deaths as AIDS, breast cancer and auto accidents combined. One out of every twenty hospital patients gets an infection. That’s two million Americans a year, and an estimated 103,000 of them die.
- The single most important way to reduce hospital infection, according to the federal Centers for Disease Control and Prevention, is for doctors and other health care workers to clean their hands in between treating patients. Research indicates that doctors clean their hands before treating a patient only 48 percent of the time, and this rate is significantly worse at some hospitals.
- Hospital infections add $28 billion to $30 billion to the nation’s health costs each year. For example, a serious bloodstream infection increases a hospital stay by eleven extra days and adds, on average, $57,000 to a patient’s hospital bill.
- In the United States, secrecy has allowed the infection problem to fester. Twenty-one states collect data on infections that lead to death or serious injury. But nearly every state has given in to the hospital industry’s demands to keep the information secret.”
Excerpted from Betsy McCaughey, Hospital Infection Fact Sheet (Committee to Reduce Infection Deaths) [Accessed February 21, 2006]
When Faced with Surgery
“No surgery is risk free. It is important to learn about the possible benefits and risks involved in the surgical procedure you are about to have. Research has shown that patients who are informed about their procedure can better work with their doctors to make the right decisions.
“Getting a second opinion is important. Your doctor, surgeon, health plan, or local medical society can help you find someone who can give you a second opinion. Before seeking a second opinion, make sure your health plan will cover this expense.
“Before having surgery, ask your physician these questions:
- What operation are you recommending?
- Why do I need the operation?
- Are there alternatives to surgery?
- What are the benefits of having the operation?
- What are the risks of having the operation?
- What will happen if I don’t have this operation?
- Where can I get a second opinion?
- What has been your experience in doing the operation? How many have you performed?
- Where will the operation be done?
- What kind of anesthesia will I need?
- How long will it take me to recover?
- How much will the operation cost?”
Quick Tips—When Planning for Surgery (United States Department of Health and Human Services) [Accessed February 21, 2006]
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