The Good News in American Medicine - Assignment Example

?American Medicine Economists in Dartmouth College in New Hampshire have studied millions of medicare billing records the results of which they published in an influential study The Dartmouth atlas of health care which deals with cost variations in American medicine. According to Dr. Elliot Fischer who runs the National scientific population health, economists have been researching for twenty years the cost variations in different communities all over the nation. A study has been conducted to compare two urban communities, Boston and New Haven which are similar in terms of good medical schools. According to the study there are two sets of differences in the spending of the two communities. 1973, Dr. Jack Wennberg who is the founder of The Dartmouth Atlas was supposed to find those communities which do not have sufficient medical care. He found extraordinary variations in medical care in some towns. One such case was tonsillectomy for children. In some towns, he found three out of four kids with their tonsils out while in another town the ratio was one out of four. 2. Researchers in National Wennberg Group on Dartmouth studied millions of medicare billing records over the years and found huge variations in treatment and spending. One thing became clear that in medicine supply drives demand, in other words people in a town with more doctors will get more doctors’ visits like if a community has twice as many cardiologists per capita, then the visits to cardiologists will be twice per capita. This can be disadvantageous as explained by Dr. Fischer “some of those services would be beneficial but the extra services provided actually don’t necessarily provide any benefits.” If a hospital has more scanners and operating rooms then more patients will get scanned or operated and in many cases they may not want or need these extra benefits and meanwhile such extra facilities add to the costs. These variations occur because there is no rule regarding the sufficiency of medical care. For instance, physicians in Northwest, demand to see patients with constant low blood pressure every six months or every year, while physicians in Miami demand to see such patients every month. As conclusion Dr. Fischer said “in a system where supply can currently drive demand, we are not getting the value that we need from health care.” 3. Doctors all over US are working towards reducing the costs of medical care. Their primary objective in this respect is to cut the cost of medical care by 25 percent in the next 5 years. Grand Junction in Colorado which is known for exceptional health care delivery has found a way to provide medical care to almost every individual at the lowest medical cost in the US. They make sure cost is kept down while every person is adequately insured and every doctor takes that insurance. Doctors in Great Junction have decided to provide medical care to all people regardless of their economic status for same fee for same treatment. They care about both physical and fiscal health of patients. The doctors have formed a group of their own to come up with an ingenious solution. They pooled the money from all the different payers and agreed on one set fee for procedures. Under this system all doctors get equal annual payments irrespective of the insurances under which the patients fall. The next step was to hold back a part of each payment that is made to the physicians and that money is distributed at the end of every year. To maintain this system Grand Junction has developed a digital record keeping. 4. Health care is something which is needed even before people are born. In many American towns there is no availability of prenatal care for mother and child if the concerned mother is without a medical insurance. Till few decades back this situation was in Grand Junction where there were too many pregnant women without insurance. The situation was such that 7 or 8 months pregnant women never saw doctors even when they arrived in emergency rooms. As explained by Steve Meacham who is a retired obstetrician “although there were government programs in terms of Medicaid and that sort of thing that would help, getting them enrolled into that was a hassle.” In 1983, Janet Grant, a certified nurse-midwife arrived in Grand Junction and with her backup physicians decided to provide medical care to pregnant women without insurance. Grand Junction set up a clearing house which helps patients to have all their paperwork done so that they can see doctors earlier. The basic idea was to provide medical care to uninsured mothers before babies are born. The program was named as B4 Babies. By providing good prenatal care to pregnant women it is possible to save money, for instance cost of premature babies which is very high can be avoided. Also, according to studies, if babies can be kept inside their mothers for one day, then a week in ICU can be saved. 5. In Seattle, Washington there have been far reaching innovations in health care delivery. In this city, most businesses are owned by their customs and one such example is GroupHealth Cooperative which treats about 600,000 people. It is a big practice with 900 doctors who work in a single building. GroupHealth is for the first time developing a new idea in health care that is becoming available in many cities of US. It is called the Patient Centered Medical Home. It is basically “a new way to manage the traditional doctor’s office.” Generally doctors are required to plan their day according to the schedule of their patients. Here, an entire medical team is responsible for every patient. This gives the doctors ample time in the morning to discuss among themselves about their patients. This system is good for both the patients and the doctors. Here, patients with multiple medical issues can access enough time from a doctor to discuss about their problems, unlike other clinics where doctors provide hardly more than five minutes for each patient. Here, doctors devote a lot of time to a single patient to oversee the treatments the patient is receiving from other doctors. 6. In Dartmouth Hitchcock medical center (DHMC) there is a practice which is quite uncommon in American medicine. Here the patients are allowed to get involved to select their own mode of treatment. This concept has been supported for years by Dr. Wennberg. According to him patients should asked about their opinion in the manner that will lead to an authentic decision. Physicians have all the clinical information about the risks and benefits of different treatments while the patients are aware of what they value. A physician can explain the effects of different treatments to his patient, for instance different heart surgeries. In this case the patient has to tell the physician whether or not he cares about chest pain. This system is termed as shared decision making which means “patients can get involved in major decisions.” In DHMC there is an entire unit devoted to this concept. Here the patients are provided with scientific literature reviews and are informed about the range of treatments for their specific health problems. Generally when a surgeon suggests surgery, a patient agrees because it is not possible for the patient to second guess a surgeon. But, in DHMC this process is more than a brief chat where the patients are accurately informed of their different treatments. Patients then can choose or not choose surgery. According to James Weinstein, CEO of DHMC under this process the rate of surgery has dropped by 30 percent. Reference http://video.pbs.org/video/2198039605/ Read More