Wednesday, November 24, 2004

US health care- the "room to room" system

Marc E Babitz, MD, department of family and preventive medicine, University of Utah School of Medicine, discusses the weaknesses of US heath care. He describes the US health care system as the “room to room to room” system. Physicians see patients in clinic exam rooms, emergency rooms, and operating rooms. To improve health care in the US, we need to focus on caring for the patient who is not in the room.

The US spends more than any other country on health care: over $1.2 trillion/year (2001), 14% of GDP, or 4,000/individual/yr is spent on
health care costs.

However, the US is last among industrialized nations in health care quality: Infant Mortality: ranking from 18th – 22nd in the world, Life Expectancy: ranking from 16th –24th in the world, Overall Health Care: 37th in the world (WHO Report 2000).

Barriers to Health Care:
Financial— 42.5 million working uninsured, 20+ million on Medicaid.
Geographical— rural, urban, transportation.
Availability— US physicians 30% primary care, 70% subspecialty, 9a-5p hours of operation, full clinic schedules (busy but inefficient).
Culture and Language.

Steps to a Solution:
1. Identify population: geographic boundaries, economic boundaries, ethnicity, children, elderly, pregnant, homeless, uninsured.
2. Assess needs: qualitative/subjective data—interviews, focus groups, surveys. Talk to everyone who has an interest in your population (e.g. government officials, parents, teachers, physicians, social workers, public health department). No one person will have “all the answers.” Quantitative/objective data—obtain epidemiological data from health department, community emergency departments.
3. Design Intervention—prioritize population needs. Interventions must satisfy the following considerations: Accessible, Acceptable, Accountable, Comprehensive, Coordinated, Continuing.
4. Assess Efficacy—measure whether intervention is making a difference. Cease intervention if no, celebrate if yes.