The gist: we often say that a system as large as a national health care system serving 300 million can't be re-invented, that it can only be fine-tuned. Gawande shows that all of the national health care systems in Europe similarly started from less-than-ideal circumstances, and that rather than arriving at universal health care through some kind of universal template, each country had to figure out what worked for them. "Path-dependence" is a cool concept, by the way.
I especially like this paragraph:
Yes, American health care is an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat. But hundreds of millions of people depend on it. The system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions. It represents a sixth of our economy. There is no dry-docking health care for a few months, or even for an afternoon, while we rebuild it. Grand plans admit no possibility of mistakes or failures, or the chance to learn from them. If we get things wrong, people will die. This doesn’t mean that ambitious reform is beyond us. But we have to start with what we have.
Read it.
2 comments:
Interesting article.
I work in health insurance now, and am pretty convinced that any attempt to overhaul the system wholesale will fail. There are too many systems, too many relationships, etc. In the UK in the 40s, we didn't have multi-billion record data warehouses storing health records.
The PTSN analogy in the article is apt. Not perfect, but the way to go.
Well, I think the point about validation of data transfer/database interface speaks more to the challenges of a national health IT infrastructure (also sorely needed) than it does to the universal provision of care.
Portable electronic records would be really cool, but I think they should be, like, step 4 on a 10-step ladder. You can have a "live" date starting, say, in 2010, that covers new patients (ie, people born after that date.) And couldn't you slowly integrate data from different sources by population segments based on need rather than trying to do a massive data dump? (ie, based on diagnoses that require complex clinical treatments - onc, transplants, and other chronic maladies.)
But I don't really know the first thing about database administration, so feel free to tell me I'm wrong! I'm like a child who wanders into a room...
Post a Comment