Good News in Health Care

Today in the US, health care is a hot--and political--topic.  The documentary "US Health Care: The Good News" examines the most efficient health care systems across the nation, and discusses what makes these medical systems so successful.

The documentary focused on one specific study called the Dartmouth Atlas Project.  The project studied Medicare billing records across the nation and found an explanation for the vast variation across American medicine that could not be explained based upon financial or economical differences between patients.  They found that in most areas, there are no clear rules about how much medical care is the right amount, and some towns spent money on unnecessary procedures.  In one town,  three out of four children had their tonsils removed, and in another only one out of four did, but both towns had the same health outcomes.  The study also found that when there is more equipment or doctors, there will be more procedures and more doctors visits.  I found the Dartmouth Atlas Project intriguing, and I was surprised how often unnecessary procedures are performed.

Another debated topic is whether or not access to health care should be right or a privilege.  In the US it is currently a privilege to have health care, but many believe it is a right.  I think that in the perfect world health care could be a right, but in reality we as a country cannot guarantee it in the near future.  Hopefully one day this issue can be resolved.

The documentary featured several cities that used innovative techniques to make their medical systems successful: Grand Junction, Colorado; Seattle, Washington; Everett, Washington; and at Dartmouth College in New Hampshire.  Grand Junction has an average family income overall, but sources tell us they have the best medical system around.  Not only did I find their system interesting, but I was also intrigued that the entire medical community was on board with it.  Everyone pays the same fee for the same care regardless of which system the patient is in and independent medical practices work together to control costs, which makes it possible to recognize over-utilization.  They withhold part of each payment, which is then distributed at the end of the year based on how well doctors did on target costs and measures.  In Seattle, the median income is slightly higher than the national average.  Their success is based on what they call a patient centered medical home.  In this system, the whole medical team is responsible for every patient leading to greater patient interaction.  Like Seattle, Everett used modern technology to save money.  They have electronic medical records and eliminated pharmaceutical representatives and samples.  Near Dartmouth, the Hitchcock Medical Center focuses on patient involvement in treatment choices.  Letting patients have more voice has led to less surgeries being performed, making the system more successful.

Important lessons can be taken from the medical systems mentioned in the documentary, and I think the way medical care is delivered can be replicated in others cities, including my own.  However, strong community leadership and commitment is necessary for these programs to work, and not every city has that.  Doctors, hospitals, and insurance companies must be collaborative to guarantee the success of such systems, and American health care as a whole has not reached this point.