Sean Khozin, MD, MPH

BusinessWeek on Regina Herzlinger’s vision of a consumer-driven healthcare system:

• Consumers tailor their own health-care coverage, navigating in a national insurance market.
• Everyone must buy insurance, and the federal government maintains strict oversight to ensure price and coverage fairness.
• Small, disease-specific hospitals care for patients who don’t need all the services offered by medical centers.
• A national database contains the prices and outcomes for procedures at every hospital and clinic, so consumers can make informed choices.
• Individuals get generous tax breaks to buy their own insurance, with subsidies for those with low incomes.

We’ve all heard stories about the long wait times in our emergency rooms (ERs). In some cases this has translated into bad outcomes, as demonstrated by the case of Esmin Green, the 49-year-old woman who collapsed and died on the floor of a waiting room at a Brooklyn psychiatric hospital.

A recent survey of ER physicians in 65 emergency departments assessed their perceptions about their working environment and their capacity to handle patients. The results show physicians lack the resources to adequately care for ER patients:

• About 40% of physicians reported that there was insufficient space for the delivery of care at least some of the time
• 50% said that the number of patients sometimes exceeded ER capacity to provide safe care

This validates previous concerns about ER overcrowding, which is making emergency care not only expensive but dangerous. So why are our ERs so crowded? Some say that the main problem is the uninsured who use ERs for their routine primary care needs or wait until they’re so sick that they have to be rushed to the ER. Although this makes sense, there is strong evidence suggesting that “the rise in ER visits cannot be primarily attributed to the uninsured.” It appears that “uninsured individuals account for only about 16% of ER visits.” Most people who go to the ER are in fact insured but they lack access to convenient care. They go to the ER because it’s a one-stop shop and, despite the long wait times, they can be seen by a physician and get their blood work and X-rays done all in one place.

Among people going to the ER are those who truly need emergency care and if neglected can end up like Esmin Green. In the real world, it’s sometimes very hard to separate such people from those who are not truly emergency patients. I think the best way to fix the problem is to focus not on providing universal coverage but universal access to care by working towards developing a more efficient and intelligent healthcare delivery enterprise.

From Obama’s website:

Sign up to lead a Health Care Community Discussion in your home, community center, or even a local coffee shop, anytime from December 15th to 31st.

Apparently Senator Tom Daschle will choose one of these discussions to attend in person.

Ever wondered what truly empowered healthcare consumers look like? Take a look at the picture below. As part of our recent community outreach and marketing campaign, we are giving free flu shots at Hello Health all week.

“got my free flu shot today from hellohealth. yay!”

Wordle is a great website that lets you generate word clouds from free text and websites by visually depicting the most commonly used words. Below is the word cloud configuration for my blog. It looks like I use the words physicians and healthcare a lot.

In the recent issue of Plastic Surgery Practice, Gerald C. Canaan, W. Scott Johnson, and Karah L. Jones write about the increasingly abrasive medical litigation environment that is one of the main reasons behind the escalating healthcare costs.The authors cite very revealing statistics, including:

• In 2003, many states witnessed malpractice premiums rising by more than 25%.
• Among the highest premiums paid by internists in 2003 were $65,697 in Miami, $50,063 in Detroit, and $41,238 in Chicago. Other specialties received even bigger blows, particularly general surgery, obstetrics, and gynecology. In 2003, general surgeons in the Miami area were paying as much as $226,542 for malpractice insurance coverage, whereas obstetricians and gynecologists were paying close to $250,000.

Looks like it pays very well to be a malpractice lawyer:

• There are approximately 125,000 active lawsuits against physicians on any given day—a number almost twice as large as the number of medical students.
• One-third of board-certified plastic surgeons face a medical malpractice claim every year.
• The average jury award in medical malpractice cases increased from $347,134 in 1997 to $606,907 in 2004.
• The escalation in settlement amounts has mirrored that of jury awards—between 1997 and 2004, the average settlement increased from $212,861 to $311,704.
• Physicians face large legal fees to defend themselves against these claims. Even in cases where the claims were dropped or dismissed, costs to defendants averaged $18,774.
• In cases that went to trial and the defendant prevailed, the average cost for physicians jumped to $95,559.

Looking at these numbers, can anyone argue with the fact that tort reform should be high up on the new administration’s agenda as the need to restore sanity to the healthcare system becomes ever more urgent?