A disconnect between medical resources and health care delivery
by MAGGIE KOZEL, MD at KevinMD.com (November 27, 2011)
Imagine what health care in the United States could look like if we devised a system that was based on sound medical practice and proven cost effectiveness. What if we put our brains, energies and passion behind designing the smartest health care system possible?
That was the question that kept poking through my train of thought as I read a study that appeared in the most recent issue of Pediatrics, the official journal of the American Academy of Pediatrics. Thestudy, out of UCLA, examined the association between length of well-child visits and quality of the visits, including things like developmental screening and anticipatory guidance. No big surprise that the longer the duration of the well child visit, the greater the likelihood that the content of the visit was aligned with recommended practice guidelines from the AAP. The discouraging news however is that one third of visits were reported as being less than 10 minutes in duration; these occurred to a greater degree in private practice. Longer visits of 20 minutes or more made up 20% of the encounters, and were more likely to occur in community health centers.
The big winners in the pinch for time? Guidance on immunizations and breastfeeding were offered in 80% of even the shortest visits. The biggest loser: developmental assessments, which don’t even achieve a mediocre occurrence of 70% until we pass the 20-minute mark for visit duration….
Our fee for service approach to health care dictates that procedures and tests pay well while addressing a child’s emotional problem gets a doctor little more than a backed up waiting room. From the patient’s view, underinsured children have to rely too much on emergency rooms, while insured parents can only get basic child rearing advice from someone with a medical degree. Health insurance companies and the pharmaceutical industry shape medical practice – and our collective health – through their reimbursement policies, marketing and aggressive lobbying. So 25% of US children are on chronic medications, while half the children in pediatric practice are not receiving basic screening and advice. The obsolete business models that the health care industries rely on are like the tyrannosaurus-rex in the room, emphasizing expensive, short term quantity rather than cost-effective long term quality, while cognitive care – a high level of skill and expertise delivered face to face in a personal manner – is what is becoming extinct.
- Maggie Kozel, M.D.: Modern Pediatrics Needs Health Care to Evolve (huffingtonpost.com)
- Why can’t the United States have a smarter health care system? (kevinmd.com)
- The culture of medicine needs to change (jflahiff.wordpress.com)
- Four Major Flaws in Our Healthcare System (triplepundit.com)
- CareSource Teams Up with the Ohio Chapter, American Academy of Pediatrics to Support Asthma Pilot Project (prweb.com)
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