The hospital was a success, but 195,000 patients died
(Alt: What will you be thinking on the operating table?)
At some point, like most Americans, you’re going to find yourself in the hospital. As the doctors and nurses hover over you, will you know how well they’ve done with other patients in your condition? Last year, about 195,000 patients died in U.S. hospitals – many of them highly-rated hospitals – not from whatever brought them there, but from preventable medical errors. So maybe you want to know how many of those medical errors happen at the hospital your doctor will send you to. You can, you should, and this information is available. Surprised?
In 2019, the United States spent $3.7 trillion on health care, over $8,000 per American. Individuals and families as well as employers spend more on healthcare than any other industrial nation. And we often beat our chest about how we’re getting the best care. We’re not. The World Health Report has ranked us 37th in the world, way behind France and Italy and just ahead of Slovenia.
Dr. Atul Gawande, who has written many books on our health care system, shows that merely keeping a checklist can save many lives. There was a study of intensive care units in Michigan that used a five-step checklist to prevent infections. It included reminding docs to wash their hands. Really? They have to be reminded? Yes. Because in just 18 months, 1,500 lives and $200 million dollars were saved. Just in Michigan. Do the math.
Any hospital that does business with Medicare – and that’s most of them – has to keep statistics on various outcomes, like infections, medical errors and deaths. They have to make this information available, to Medicare and to you.
Why should this be important in a city with so many great hospitals? Because Philadelphia ranked last out of 67 Pennsylvania counties in community health indicators – the rising costs that lead to bankruptcies, steal from education and infrastructure, break city budgets, and deprive many of insurance coverage.
This is shocking, considering that Philadelphia pioneered standardization of hospital statistics. In 1917 Dr. Chas. Scott Miller proposed the Philadelphia Plan to help us study outcomes and death rates, and get meaningful information about hospital performance.
Yet nearly a century later, we’re still not there. Healthcare-associated medical errors are estimated to be one of the leading causes of death in the United States. If you or a family member require medical attention, there is no guarantee you will leave the hospital in better health than when you entered, thanks to sub-par or inconsistent care.
The good news is that this is preventable: we can reduce medical errors. President Obama’s 2009 stimulus package included over $1 billion for Comparative Effectiveness Research – studies of which health care practices work best for which patients. (If you thought hospitals automatically did this, you were unfortunately wrong.) Maryland has a CER system, which has helped John Hopkins to be the top ranking hospital in the nation, if not the world.
Beyond errors, what about costs? What if all hospitals provided you with prices of services that are relevant to patients? What if our region and state adopted an all-payer system, where everyone agrees on the charges for common services in a transparent manner? Nearly all the hospitals in the Delaware Valley are not-for-profit. Your tax dollars are helping them to provide care, but you aren’t getting any accountability in return.
American healthcare has many problems. Costs and outcomes (medical talk for “results”) are both trending in the wrong directions, and too many Americans are uninsured. The toxic political debate doesn’t help. There are many reasons for our problems. But a government magic wand can’t fix all of them. It will take government, hospitals, doctors, Big Insurance, Big Pharma, and other players all working together to make a difference.
And one more player: you.
“What can I do?” you’re thinking. You can pay attention, especially when your own spleen is on the line. Demand accountability from the medical resources that benefit from our taxes. Demand public reporting of meaningful information about the healthcare outcomes. Demand that our politicians use facts rather than opinions in discussing healthcare policy issues.
We can achieve a healthcare system that is affordable, and provides quality care for all of us. Here are a few goals that are entirely reasonable. By October 2015, we should aim for ZERO healthcare-associated infections, ZERO medication errors, ZERO preventable injuries, and ZERO healthcare-associated pressure ulcers (medical lingo for “bed sores”). Does that sound utopian? It isn’t. All of that, and more, can be done.
What do we need to get there? Transparency and awareness. We The People must reclaim our voice in the political discourse of our nation. We can’t leave it up to government, or even to private industry, to fix the system. We must ask, insist and demand. And by “we” I mean you, too.
Dr. Shimon Waldfogel is a psychiatrist at Abington Memorial Hospital, and founder of Citizens4Health (www.citizens4health.com), an organization working to advance the conversation about making health care more affordable and successful.