Print version ISSN 0042-9686
Bull World Health Organ vol.79 n.4 Genebra Jan. 2001
US health care takes a battering
The United States health care system fails to deliver consistent, high-quality health care to its citizens, and without a major overhaul the problemwill continue, according to a new report fromthe Institute of Medicine (IOM) of the US National Academies. The report outlines the problems hobbling the countrys health care systemand describes changes necessary to fix it.
The American health care system offers the sophistication of a space station delivered with the efficiency of a third-world post office, says Dr Lucian L. Leape, a physician at the Harvard School of Public Health and a member of the IOM committee that drafted the report. The report blames a highly fragmented delivery system that largely lacks even rudimentary clinical information capabilities for the gap between the calibre of care possible and the quality typically delivered. The committee also criticizes a health care system that frequently falls short in its ability to translate knowledge into practice and to apply new technology safely and appropriately.
The shortcomings the committee found arent unique to the US. Dr Tessa Tan-Torres Edejer, with WHOs Global Programme on Evidence for Health Policy, says: The few data that we have suggest that the same problems exist in just about every country, with some countries relatively worse, and some better off. Invariably, the countries that look for problems, find them. Australia and Mexico are two countries she recalls that conducted recent studies revealing malfunctioning areas of their health care delivery systems. There are probably many others but these are not reported in the scientific press because they are meant for internal use.
The problems of the US health care system cant be resolved without a complete overhaul of the current system, the IOM committee argues. The current care system cannot do the job. Trying harder will not work. Changing systems of care will. To this end, the committee established a list of guidelines for improving health care in the US. These include a shift toward patient-focused care. Right now the systemis designed around what doctors can deliver, rather than on the care that patients need, says Leape. The report says patients must be given greater control over their care, and greater access to current health information.
The report also calls for better communication between health care practitioners. The big secret about the American health care systemis that no-one is in charge, Leape told the Bulletin. He says the current system consists of separate care givers who work as individuals rather than as groups, and this lack of communication means that care is often duplicated or second-rate. The report calls for health care providers to make greater use of information technologies, such as the internet, to better coordinate patient care and increase efficiency. Other priorities include keeping providers informed about current scientific knowledge and providing health care for the nations 40 million uninsured citizens.
In addition, the committee urges US government agencies to identify at least 15 of the most common chronic conditions and develop strategies for managing them over the long term. We need to shift the focus to managing chronic disease instead of merely treating single episodes in isolation, Leape says. The obvious question now is: Who is going to make this happen? Weve asked for the allocation of funds to begin making these changes. But whether that happens or not is a political decision. Its unclear what will happen in the current political climate.
WHOs Tan-Torres Edejer adds that all countries would like to have a health system that provides seamless top-quality service wherever the patient accesses the system, from the family physician to the high-tech hospital. However, I dont know of any country that has reached that ideal. Perhaps the US, with its capability and penchant to use management models from other sectors, like the error reporting systemin the aviation sector, and to take advantage of the latest technology, has the potential to get close to that ideal. But as the IOM reports, even the US system has still a long way to go.
Nederland, Colorado, USA