Health Care Is Not an Insurance Product

I don’t know about you, but the political rhetoric around health care insurance has exhausted me. I am also very disappointed that few, if any, of the members of our government are being driven by any sort of objective data. Let me show you what I mean.

First and foremost — HEALTH CARE IS NOT AN INSURANCE PRODUCT.

I wish everyone that talks about what needs to be done would start from this point of view. It seems like 100 percent of all of the discussions are about insurance, while ignoring that insurance is at least one step — if not three or four steps — removed from health care itself.

Delivery of health care to individuals has been a data-driven activity since before the establishment of the first hospital in Philadelphia in 1751. Since 1970 there have been three sentinel events in this regard that have really focused on use of data in the treatment of patients:

1. The problem-oriented medical record,
2. The advancement of evidenced-based medical decision making, and
3. The advent of the personalized medicine movement.

Dr. Lawrence Weed developed the concept of the problem-oriented medical record to provide a highly organized approach to the multiplicity of problems faced by clinicians on a daily basis. This development provided the foundation for many of the improvements in the delivery process.

I want my health care to be based on scientific evidence and not just the opinions and beliefs of a clinician that may have completed training a decade ago. The advancement of evidence-based guidelines has built upon the foundation laid by Dr. Weed and continues to ensure that many of us get the best care possible.

Finally, the personalized medicine movement brings all of this knowledge and expertise into focus for one specific individual — me.

So what results do we currently get from our health care system? According to the number crunchers at the Centers for Medicare and Medicaid Services health care spending is projected to grow faster than the US economy over the next decade.

 

TOTAL SPENDING	$3.35 trillion
Per capita spending	$10,345
# Primary care providers / 1,000	2.6
# Hospital beds / 1,000	2.9
Life expectancy
Men	71.5
Women	78.3
Infant mortality	10%
Average hospital stay	5.5 days
Drug costs	$897 / capita
Hospital admissions / 1,000
Asthma	120
Chronic obstructive pulmonary disease (COPD)	203
Congestive heart failure (CHF)	441
Hypertension	49
Diabetes	57
Diabetes amputation	36
MRI scans	91
CT scans	228
Cancer mortality rates
Cervical	2.1%
Breast	20.7%
Colon	14.4%
Hospital fatalities
Acute myocardial infarction (MI)	5.1%
Hemorrhagic stroke	25.5%
Ischemic stroke	4.2%

 

What could we get if we rigorously applied data to our system instead of politics? I pulled comparative statistics from the Organisation for Economic Co-operation and Development, which tracks and reports on more than 1,200 health system measures across 34 industrialized countries. Here’s some comparative health care data from the 12 most industrialized countries:

 

TOTAL SPENDING	$1.87 trillion
Per capita spending	$5,765
# Primary care providers / 1,000	4.1
# Hospital beds / 1,000	8.2
Life expectancy
Men	73.3
Women	79.6
Infant mortality	6.8%
Average hospital stay	6 days
Drug costs	$461 / capita
Hospital admissions / 1,000
Asthma	42
Chronic obstructive pulmonary disease (COPD)	192
Congestive heart failure (CHF)	188
Hypertension	52
Diabetes	19.5
Diabetes amputation	12
MRI scans	40
CT scans	108
Cancer mortality rates
Cervical	2.2%
Breast	23%
Colon	19%
Hospital fatalities
Acute myocardial infarction (MI)	3.8%
Hemorrhagic stroke	23.5%
Ischemic stroke	4.9%

 

We don’t even need to invent anything new to save $1.5 trillion per year. All we have to do is apply processes, policies, and data that have already yielded results to our delivery model.

I say we tell all of our politicians to sit down and shut up and we start today.

What do you say?