the Rosetta Stone

Ambitious global attempts have been undertaken to analyze many countries’ healthcare systems to document what has facilitated positive change and what has not. Everyone then armed with the data sit and pour over the stacks of paper to figure out how to better our healthcare system and suggest policy. Once it gets to the sub-committee though it dies a slow death to be transformed into some would say pork or other type of species the public would rather not look at.

One such an attempt to dig into the world health care systems is the World Health Report of 2000 which used weights to create an index of quality care. Using a composite of the twelve most industrialized nations they tabulated results and ranked them. Based on how well their health system works Greece ranked 14 with universal access and national healthcare services, the United States ranked 37 with variable access and supplemental insurance and Brazil ranked 125th with universal rights but contracted and national services. The US had a rank of 7th out of 12 that encompass a national system of healthcare, but those of higher ranking invariably provide universal healthcare while the US does not.

Statistical infant mortality’s also have been used as a measure of healthcare effectiveness in a country as well. Infant mortality’s in studies have been measured comparatively while in other studies within countries. In Australia, it was found that the lowest two classes set above the bottom class had 23% of the total infant deaths. These were the semi-skilled and skilled working class, and not the poorest unskilled. If you think about it his has implications for the US because these classes of people, who are also within the United States, are unlikely to be poor enough for US social insurance policies but not rich enough to afford healthcare. By implication if we have a very high infant mortality and 45 million are uninsured then infant mortality is a very good indicator of those who were poorer and uninsured, but employed with an income great enough to not be eligible for state run insurance.

In other words if similarities exist among certain countries and situations with their people then you can be certain that the statistics do not lie. You cannot fight statistics, except through misinformation and fear of change.

Unfortunately, the US links together voluntary insurance with private employer insurance and social insurance to provide healthcare coverage with the largest social insurance coverage administered through Medicare and Medicaid for a total of 17.3% of the US healthcare expenditures in 2000. Each country that has mixed coverage healthcare benefits have one common detriment in that all have issues ensuring quality on all the levels the mixture provides and in cost effective means, hence the current debate on universal healthcare and cost.

Everyone wishes for high quality healthcare but measuring the quality of care and improving it can be difficult to quantify. Continuous quality improvement, total quality improvement and the ever present process re-design are just a few of the many methods available to a healthcare systems management. But how can hospitals and other large clinical facilities find the money necessary to re-design ageing buildings, and retrofit older EHR/HIT systems, or throw them out and upgrade complexly? If we rank 37th in how our health system provides for its citizens but we spend the most per-capita on health care where is all this money going? Hospitals are not receiving this money, their rates from Medicare, Medicaid and HMO insurance have been cut progressively over the years. In a few words: Follow the bread crumb trail of current health insurance commercials back to the source. While watching the news count how many health advocacy commercials and the words they use are for or against universal healthcare, note words such as experimental and government run are used.

A partial explanation of how costs are incurred by a hospital and how they are locked into a poor revenue stream is noted below:

In any organization, some aspects of the entity will drive costs and other parts will drive revenue. In a healthcare organization, cost centers generally do not have contact with clients and therefore are likely to induce costs without providing the corporate entity with income, that is the hospital. Most hospital expenses are fixed until a set point when new staff, equipment or even facilities are needed which creates a credible reason for strategic planning. Hospitals are constantly planning, why? They have very ridged streams of income but it is predictable so planning for new equipment, more staff or technology updates can be estimated for and monies can be allocated over time. There is little in the way of providing profitability to the organization except for fee services and perhaps donations. But, donations are down and fee for service has just about vanished into a relic.

A few ways hospitals are getting by with less is the electronic storage of documents and data; paper charts have to be stored while electronic charts can be expanded indefinitely and shared among facilities within the system. Electronic data has the capacity to be readily available and the details of the raw information can be adjusted for the specific treatment of each patient and return patients. One such very successful system was implemented by the U.S Military, AHLA which services 9 million patients through TRICARE.

Sadly, sometimes an economic loss cannot be contained with technology, restructuring or otherwise and divestment or a selling off of unprofitable components of the organization can occur.

1 stone = 6.35029318 kilograms

With efficient patient scheduling for appointments cost savings can result as well. There are many methods to schedule appointments, some being: standard, wave, resource-based, and open access scheduling. To facilitate payment to the physician or physician group, or reimbursement for services from insurer, CPT coding is used as well as statistical implications for payment on the insurer side such as usual, customary, and reasonable payment schedules, dictated by the data the insurer obtains over time in a geographical area. So this is being creative, squeezing money from the stone. So who are the people and organizations not being creative?

In 2000 we spent 4,499 dollars per person on health care but in 2001 as quoted from the book Health Care Administration: Planning, Implementing and Managing Organized Delivery Systems: 4th ed by Lawrence F. Wolper, 48 million Americans were without health insurance. In 2000 Medicaid accounted for 15.6 percent of all health care costs, while Medicare accounted for 17.3 percent of all health care costs for that year. In the year 2000 out of pocket health expenses comprised a total of 15.3 percent of total health care expenditures for that year. Ask yourself, “Where all the other health care expenditures came from, how were they paid and by what organizations?” and “Why were so many people uninsured then and are now?”

Why are hospitals doing without, our infant mortality so high. In 2004 our infant mortality rate slipped again to 23rd in the world. Why do we spend 10 to 20 percent of our personal income on our health care bills-the out of pocket costs and premiums? It should be noted that these costs are not associated with Medicare and Medicaid, they are from employer HMO sponsored plans. Why are 100 hospitals cutting more than 50 doctors and staff at a time when we spend so much? Hospitals are hurting, we are hurting, who or what organizations are not? What organizations have had enough cash to provide lots of health care commercials during your news hour? Again a link brought up on an early post that shows how hospitals are hurting in this recession. See the bottom link on going lean for other ways hospitals are getting creative or rather money from the stone: AMA Hospital Crisis

Hospitals Going Lean

Health Reform

APHA Infant Mortality?

Related posts you might also like: