The public cares so much about health-care delivery because it’s their pain and suffering. Patients’ lives and pocketbooks are on the line. Medical bills are the leading cause of bankruptcy. Politicians care because they want to hold the line on taxes, while health care and associated entitlement programs are budget busters. The ardor with which physicians argue has to do with professionalism, income, and independence. American health care: what is the good, the bad; and where is it headed?
Medical tourism delineates the practice of the ill to travel abroad for care and treatment. They usually do it to save money. An estimated 750,000 Americans spend $15 billion per year on medical care in other countries. Patients Without Borders estimates Americans save on treatments abroad by specialists and for procedures on average: Brazil: 20–30 percent, Costa Rica: 45–65 percent, India: 65–90 percent, Malaysia: 65–80 percent, Mexico: 40–65 percent, Singapore: 25–40 percent, South Korea: 30–45 percent, Taiwan: 40–55 percent, Thailand: 50–75 percent, and Turkey: 50–-65 percent. Continue reading
Hospitals are buying out private medical practices, making physicians employees of the hospital corporations. Yet there remain more than a quarter of a million physician practices in the United States. The American Medical Association estimates that more than half the physicians they surveyed in 2013 are self-employed, and 60 percent work in practices owned by physicians. The report contains other data about specialists and family practitioners, but looking forward, the AMA warns the challenges to independently employed primary-care physicians will increase with pressures building in changing payment and health-care delivery pathways.
Medical Economics (medicaleconomics.modernmedicine.com) delineates fifteen greatest challenges facing physicians in 2015. They are formidable, expensive, and time-consuming to overcome and may hasten private-practice physicians and groups down the same path that led to the expiration of independently owned neighborhood pharmacies. Continue reading
American health-care delivery needs fixing. Two recent responses are addressing access issues to medical care by insuring the uninsured and digitizing medicine, especially medical recordkeeping. Americans like to fix things by doing more of the same in bigger ways and expect technology to solve the rest.
Obamacare addresses the former. Doctors resisting the push to digitize medicine and medical recordkeeping face off against three advocates: private industry inventing and selling new technology; millennials wanting more control over their own medical information and decisions about their health care; and the federal government. The government wants all medical records digitized, creating an open-access system across specialties for better information sharing that benefits patients. Officials also want to streamline Medicare and Medicaid billings primarily to expedite payments to providers and prevent errors and fraud. Continue reading
Even the cigarette companies no longer contest the science that smoking their products is a health hazard for the smoker, second-hand smoke is dangerous to others in proximity to the smoker, and cigarette smoking is a major public-health hazard. Science has been unable to make cigarettes safe, but marketing experts have made them acceptable in society. Science is also developing safer alternatives, and new rules and regulations need to be developed addressing these advance technologies.
The number of cigarettes smoked by teens is reportedly falling. Perhaps it is due to effective education and tobacco-control programs taking hold, more effective means of quitting smoking, the change in cultural attitudes, or extraordinarily high taxes on legal cigarettes putting them out of reach for many kids. Nevertheless, we just passed 50 years since the US surgeon general launched a crusade against smoking. The half-century-mark report “The Health Consequence of Smoking—50 Years of Progress” was issued in 2014; anti-smoking is now considered one of the “winnable battles” in public-health priorities. Continue reading
Many professions including engineering, architecture, and aviation and aeronautics use checklists. Teachers use them creating lesson plans about what material to cover with students and when to introduce new material. Manufacturers use checklists throughout the production process to ensure product quality.
Checklists are the basic tools of epidemiologists and public-health officials investigating and tracking disease. Medicine is finding them useful tools in creating a culture of safety. Continue reading
Population health management is one of the ten most pressing issues for hospital administrators, according to a survey report from the American College of Healthcare Executives (Copyright 2015). Hospitals have routines and checklists of to-dos for each presenting patient. There are checklists for disinfecting operating and recovery rooms to prevent infections. However, good patient-health-management outcomes depend on patients having checklists too. Good health-care management depends on all actors fulfilling their obligations, and checklists are props that help achieve the best quality care. Continue reading
Cutting health-care overhead costs and improving health-care outcomes require innovative thinking as much as bean counting. One exercise is using predictive modeling strategies through the use of health-care analytics that I discuss in a previous article.
Hospital administrators create predictive models of probability of behavioral outcomes based on data and apply them to management issues. Doctors do the same relative to patient care and outcomes. They must both adjust for changes in probabilities that occur from external forces and unanticipated consequences of decisions. Technology is frequently used in modeling. Continue reading
Referrals of patients are the grease that makes the health-care delivery system interactive and user friendly. Family practitioners refer to specialists. Hospital social workers refer to nursing, skilled care, and rehabilitation facilities. Patients are referred to surgical units doctors like best, and in the vast majority of cases, in the best interests of patients.
Countless laws, rules, and regulations govern referrals because containing fraud in the health-care system is a top government priority. Protecting patients and forefending fraud and conflicts of interest are paramount tasks. Medical service business plans ought to include strategies for avoiding referral fines and penalties. They can be severe. Continue reading