Redefining Health Care: Creating Value-Based Competition on Results

5 Responses to “Redefining Health Care: Creating Value-Based Competition on Results”

1. Patricia Fitzpatrick says:

   April 18, 2010 at 9:12 am

   Having experimental the healthcare industry for the last link of decades, I want to top out a flaw in the author’s recommendations:

   Poor people are ignorant people. Ignorant people have no thought what are the apt “outcomes” in medicine. Telling a four hundred pound diabetic that the key of excellent health can’t start with making Huge Macs disappear down his gullet, is the kind of strategy that produces massive and profound excellent “outcomes”. Finding more well-organized ways for the poor to avoid the consequences of this behavior and other truly stupid life choices is a way to more terrible outcomes.

   Middle class people are tender into the poor people category where wishful thought and immaturity reign supreme in large numbers. (if someone’s giving things away, it’s best to get in the head of the line, not the end) Telling someone that they have caused a health problem makes them mad and resentful rather than relieved. Logically, one should rejoice that if they caused a problem and can then solve the problem, they can save a whole lot of time, money, and worry. Instead, they doctor shop and demand more and costlier diagnostics/treatment to avoid facing a life-style choice. So we should find more ways to let them? And make them more pleased about it?

   Getting people to be more pleased with the healthcare industry means giving them more of what they don’t need and hiding more of what they do; the truth.

   We went recently from a major metropolitan area with a high populace of upper income earners to a small, rural place with a high number of minority and welfare recipients. The local sickbay, which is in the district seat, rates a consistently higher level of satisfaction among patients than the rich area.

   Richer people have far less time, desire, and need to use the facility than the poor. Richer people pay more of the bill and have a better thought of the real value as correlated to cost although even their understanding is truly pitiful in relation to what they should know. And there’s more incentive to stay away from it; they have jobs taking up some part of the day. Poor people careen from one self-inflicted crisis to the next and have bounty of time to swamp the sickbay resources.

   But more significantly, the sickbay administration is hell bent on patient satisfaction surveys. In order to maintain their high rating, they are literally giving away health services to the poor (with taxpayer dollars, naturally). The more they give away to people, the more people line up to get it. Knowing that health care is being handed out more efficiently and with a smile is a recipe to place a bullet in the heart of the system now in place. Make it a silver bullet and promote a movie showing the gory end is the best way to get this whole thing settled, once and for all. But I don’t reckon that’s what the author proposed.

   Just one example, although I may possibly swamp this site with more and still not run out; patient is a chronic substance abuser well known to the community. He gets on a bike at two in the morning because the bars are closed. With no protective or reflective gear on, wearing dark clothes, biking by the side of a route with minimal lighting, and sporting a blood alcohol four times the legal limit, he swerves into the street where a hapless motorist hits him.

   A few hundred thousand dollars and a week later, there’s a disposition hearing at the sickbay on what to do about a bum that is never going to pay this huge bill. Choice? Keep him in this acute care facility for the next thirty days so that the sickbay can payment the state from its indigent fund.

   How does the bum like free room service and drugs. A+++

   When all is said and done, is our customer, the bum, well served by a facility providing for his every possible need? Just question yourself how do you reckon he can afford to be a bum? (BTW, Mr. Bum turned down the motorist’s auto insurance based settlement of $10,000. Even though the driver wasn’t at fault, the company knows the cost of the nuisance lawsuit. But even that won’t cut it nowadays for our liability lottery.)

   Give the bum a better deal? No. Give him the right deal; patient, heal thyself. Now that’s a excellent (and cheap) outcome!
   
   Rating: 1 / 5
2. R. Cruz says:

   April 18, 2010 at 11:30 am

   Released by the Harvard Economics Professor early in 2006, Michael gatekeeper and his coauthor Elizabeth Olmsted Teisberg attempt to argue for the need to exchange competitive strategies in the United States’ health care sector.

   Health Policy has never been so critical. Countless scholars have attempted to suggest remedies for the people’s ailing health care system and just about everyone has failed. This book is another example of a failed attempt to show ‘what needs to be done.’ This work is by no means a blueprint for health care reform.

   Neither author comes from the health care setting. Both professors are in fact scholars of economics and business strategy. Neither author has no right impact of what it is like for patients to be in the acute care setting. For example, the text contains a contradiction as to the importance of the patient’s self-awareness and involvement in his or her care. On page 246, the authors mention that the thought that “patients can or should become medical experts and direct their own care is misguided and unrealistic.” But, on pages 298, 299, and 436, the authors top out that being an “informed” patient not only requires “greater involvement and responsibility”, but also that “patient responsibility” … “enables treatment to succeed.”

   This text is truly a disappointment as it leaves out so many of the flaws in this health care system that really need to be revamped. There is no mention of the need for acute care hospitals having patients in private rooms only as different to dual-occupancy rooms. The growth of antibiotic-resistant strains of microbes have gotten sincerely out of control necessitating the need for facilities to have single-occupancy patient rooms. There is no mention of the impact of the nursing shortage. Nurses have to fight for their wages, face heavy workloads, deal with understaffed settings, and live with an ongoing professional lack of respect. There is no mention of how unprepared sickbay settings are for overcrowding or disasters. The demand for competent nursing has been so fantastic that certifications such as pediatric advanced life support or advanced cardiac life support have been made far more simpler to pass so that even ill-prepared workers may obtain such certifications. Sadly, despite the fact that individuals may want careers in nursing, clinical instructors at community colleges or universities are truly gone. Free market theories fail to apply to the nursing shortage dilemma because of the complexities of this kaput health care market.

   Another contradiction exists with regard to a lack of a health care system coordinator. On pages 51 and 296, the notion that there is “piecemeal,” “disjointed,” or “broke ” care is evident in that “there is often no physician to help navigate the system and make sure follow through.” Yet on page 251, there is mention that nurses “specializing in the particular disease works with the patient to be sure that the in rank available is understood” and that on pages 247 and 250, nurse health advisers provides “outreach education to patients before and after hospitalization, guidance on health risk management, and health coaching and referral help” – patients are “guided through the administer by a skilled nurse who not only supports the initial choice of source but also becomes the adviser over the course of treatment.” Nursing, therefore, helps acclimate the patient into the system to coordinate care. Ideally, this is what nurses do. Not all nurses do this of course, but just like physicians, some nurses are better than others.

   I would have expected more from professors of the University of Virginia and of Harvard University. The authors even misspelled and left the ‘r’ out of the word “stroke” on page 118.

   I strongly disagree with the authors’ notion that consumers should not be medical experts. People in general need to know how to take care of themselves. They need to exercise, eat aptly, be in health relationships, and to know how to manage stress. They need to see their physicians and take whatever medications their bodies require. It is a ludicrous argument that consumers or patients know which physician or sickbay has the best outcomes. Physicians and sickbay workers make mistakes. And “human” mistakes in hospitals or any health care setting will never stop to exist.

   Lastly, on page 359, the argument in support of specialty hospitals is a poor one. For example, far too often, patients that go sour in outpatient surgical centers need an inpatient admission into an acute care sickbay. Expenditure increase due to the need for a facility to facility ambulance transfer as mandated by federal laws. Further, the need for staff well-versed in resuscitative methods demands hours of costly training that hospitals are forced to comply with.

   This book needs to go the the fiction section of the book store. The book ignores very pricey aspects of health care such as AIDS/HIV, psychiatric care, and ambulance diversion in the midst of emergency room overcrowding. Sadly, only in “Fantasy Land” will their theoretical notions and recommendations take hold.
   
   Rating: 1 / 5
3. Steven Merahn says:

   April 18, 2010 at 1:43 pm

   gatekeeper and Teisdale have clearly never spent any time really administration a healthcare service operation; if they did they might not have written this book. Even as the concept of adding value to the lives of patients is critical to the success of the next iteration of the American medical system, their attempts to define the path to building value are delightful constructs that will only tie up the minds and methods of genuine healthcare professionals who are desperate for any judgment — and books like this only serve to delay the actual evolution of the human services professions. Please be careful when you read this — it has small grounding in reality and 5-7 years from now may be as helpful as sanitariums for tuberculosis.
   Rating: 1 / 5
4. Merijn says:

   April 18, 2010 at 2:06 pm

   Michael gatekeeper presents a clear insight of the US health system which is flawed in many ways.
   Rating: 5 / 5
5. Linda French says:

   April 18, 2010 at 3:33 pm

   this book had some excellent thoughts that may possibly have been conveyed in less than half of the space. It was quite redundant.
   Rating: 3 / 5