Sunday, July 4, 2010

Our Screwed-Up Health Care System, Cont. With Example:

This New York Times article giving advice to prospective joint-replacement patients unwittingly perfectly summarizes the problems in our health care system.

To wit, the bad comparative results:
In the United States in 2007, surgeons performed about 806,000 hip and knee implants (the joints most commonly replaced), double the number performed a decade earlier. Though these procedures have become routine, they are not fail-safe…A study published in 2007 found that 7 percent of hips implanted in Medicare patients had to be replaced within seven and a half years….The percentage may sound low, but the finding suggests that thousands of hip patients eventually require a second operation…Those patients must endure additional recoveries, often painful, and increased medical expenses…The failure rate should be lower, many experts agree. Sweden, for instance, has a failure rate estimated to be a third of that in the United States.

One of the problems is a lack of infrastructure—Sweden (and Australia as well for sure; presumably most other non-screwed up developed nations have similar stuff) has a joint replacement registry that allows surgeons to look at the data and determine whether particular brands, makes, etc. are defective or what-have-you.

The other problem is the overreliance on the brand spanking new:
In general, be wary of the latest, most advanced new joint. There is little evidence to support the use of more expensive designs over basic ones, said Dr. Tony Rankin, a clinical professor of orthopedic surgery at Howard University. One recent study found that premium implants fared about as well as standard implants over a seven- to eight-year period.

Then there’s the interesting little hint of a possible future:
A study published in The Journal of Bone and Joint Surgery in 2004 found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year.

The researchers documented a similar trend when it came to hospital volume. Patients at hospitals that performed more than 200 knee replacements a year fared better than patients at hospitals that performed 25 or fewer.

One of the possible futures of health care is a mass-produced one. India, for example:
Indian hospitals have found that error rate are reduced when their doctors specialize and perform many procedures of a similar kind. The time for operations is also cut down, with no loss of safety. A focus on eliminating unnecessary frills and on utilizing expensive resources like doctor time most effectively also helps even though good surgeons in India earn about as much as surgeons in the United States, the cost of operations is often an order of magnitude lower.
So there’s the thought that joint-replacement (as with, for example, LASIK eye surgery) might become something that you go to a specialized clinic, with a predictable price and predictable time and so on and so forth.

It’s examples like this—and the reality that there are so many others of this type—that both despair and inspire confidence. Despair in the sense that the system is just so screwed up and remember what happened when we made some first efforts at reform? Confidence—or more properly inspiration—in the idea that: how much better would the economy and country be if we could figure the whole dang thing out?

No comments:

Post a Comment