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Showing posts from March, 2010

The evolution of the hospital meeting on reducing spending and improving quality

We have had 3 of these meetings so far at our hospital, and so far the interest level has been high, and the ideas have been good.  This next meeting, this coming Tuesday, catches me just after returning from Haiti, and may be losing some momentum, what with the recent passage of the health care reform package.

I would propose at this meeting to do several things.

First, I think that we should at least discuss gathering cost data for the hospital. I would like to know what the average patient or patient's insurance company is billed for various diagnoses, as an inpatient and in the emergency room. I would like to know how much the hospital actually gets paid.  I would like to know how much uncompensated care is delivered, and would like to see what impact health care reform has over the next year. I know this kind of data is sensitive, but without it we are working in the dark.

I would like to go over the provisions of the health care reform package in a little more detail to see …

How do Haitian patients' expectations resemble those of American patients?

My trip to Haiti was satisfying, the people remarkable, and though many things about Haiti were very foreign, there were some definite and unsettling areas of similarity between the patients I saw there and those I see in the US.

I expected to see people with horrible and potentially curable injuries and infections, and thought that bringing antibiotics would be exceptionally useful. Instead, I found that most people were very healthy, and that they had complaints that didn't correlate with any physical findings of ill health, and which certainly were not life threatening. Many of these discomforts appeared to be related to various forms of overuse, such as headaches related to carrying five gallon buckets of water on their heads for long distances, and pelvic disorders related to having many babies.  In general they were disappointed if I didn't have a drug or a test for their particular condition, and many were unconvinced or under-impressed with my explanations for their sy…

Welcome Home: Health Care Reform Bill Passes Congress

I just got back from 2 weeks in the Haitian island of LaGonave to find out that in my absence congress actually passed health care reform.  Organized medicine is generally in support of it, as I am generally in support of it, and I hope that we can now get to work and do what we can to make it live up to what I see as excellent potential for reducing costs and improving quality and accessibility.

On my dining room table, though, was the local newspaper, with a headline about our governor, Butch Otter, who had been fuming that Idaho would resist enactment of the new bill. Some information just makes me tired, and seeing this explosion of outrage over something which, though certainly not perfect, is a really good start, makes me tired. I then read an article in the New England Journal by T.S. Jost which addressed the issue of state resistance to health care reform.  He expresses the issues well, and with good detail.

"I know of two other significant state campaigns — oneongoing, on…

a nearly instant solution to health care woes

Most peoples' health care needs are, or could be, taken care of by a primary care doctor. These needs are not being met because primary care providers are both too expensive and in short supply. A standard doctor's appointment may be billed at over $100, easily, and cost even more if lab tests are ordered. The uninsured just can't afford it, and the insured are hurting because their insurance costs so much, and this is in part due to the fact that care is expensive, and that patients go for more expensive urgent and emergency care because they can't get in to a primary care doctor.

But primary care is not very expensive at all to provide. A good full time primary care doctor manages 1600-2000 patients at a time. If each one of them paid $200 each year to that primary care doctor, the doctor could make a good salary and handle the 50-60% overhead which is common in medicine. Most of the uninsured could afford that much money, and it is far less than is usually spent on …

watching Cspan

During my lunch hour (25 minutes more like) I went to the gym where I caught up on a small portion of TV.  I have been avoiding the news about health care reform legislation lately because it feels like an “Obama’s gonna fail” fest. But today I had a TV all to myself and there was a representative from New Hampshire on CNN, telling me, live, how he felt about the budget reconciliation process and the health care reform bill that might pass.

The Republican congressman said about what the standard line appears to be about health care reform: “The majority of Americans don’t want to see this bill pass.”  He said that it was too expensive, that small business would no longer be able to afford health insurance for employees, that it would put 17% of the nations economy into the governments hands, that it would make health care a puppet of the government.
It is absolutely clear from this that he hasn’t read the health care bill.  It has many faults, but what he said was grossly inaccurate. …