Trends in health outcomes and healthcare costs are not good.
This BLOG entry today is not looking to assign blame. But we must recognize that many very troubling trends continue to tell a story and hopefully demand more action: healthcare transformation is moving far too slowly.
We can’t afford our system! And worse, it seems that more, not less harm is being done…
Yes, JAMA reports today that medical errors are the third leading cause of death in the United States, (just behind heart disease and cancer! ).
Dr. Martin Makary, a professor of surgery and of health policy and management, and Dr. Michael Daniel, a resident in internal medicine, both at Johns Hopkins, averaged the medical error death rates estimated by 4 studies published from 2000 to 2011 and used this number to derive an estimate at the national level based on 2013 hospital admissions. Using this approach, they estimated that medical error accounted for about 251 454 deaths, which represented 0.71% of hospital admissions in 2013.”(emphasis added)
This number is the equivalent of 838 jumbo jets crashing every year!
“Medical errors are often simply not reported on the death certificate,” according to officials at the National Center for Health Statistics (NCHS).That’s a big problem, said analysis coauthor Martin Makary, MD, MPH, “because the US list of most common causes of death informs many national health priorities each year in terms of funding and health policy.”
We’ll come back to this at the end of this post…
But to conclude on the astonishing number of deaths caused by medical error, here is some further perspective which underscores that our efforts at transformation are not working very well: “This number (251,454) is more than double the oft-cited statistic that as many as 98 000 people die in hospitals from preventable medical errors every year, published in the landmark 1999 Institute of Medicine patient safety report To Err Is Human: Building a Safer Health System (http://bit.ly/1sdN7Vv). The source for that 16-year-old statistic, which Makary says has become “ingrained” in the medical field, was a 1991 analysis of data from 1984. Drs. Makary and Daniel, wanted to revisit this “limited and outdated” figure, they wrote in their study.”
They weren’t the first to do so. In 2005, two authors of the To Err Is Human report, Lucian Leape, MD, and Donald Berwick, MD, wrote that “subsequent data from various sources suggest that the IOM may have substantially underestimated the magnitude of the problem” (Leape LL and Berwick DM. JAMA. 2005;293[19]:2384-2390). Leape and Berwick pointed out that hospital-acquired infections alone explained more than 90 000 deaths per year and that most of these events were preventable.”
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And as to cost of health insurance:
The 2015 Employer Health Benefits Survey of The Henry J. Kaiser Family Foundation indicates that “Annual premiums for employer-sponsored family health coverage reached $17,545 this year, up 4 percent from last year, with workers on average paying $4,955 towards the cost of their coverage”.
While it is often reported that the 4% increase is much less than the double-digit increases of the past decade, the cost trend in relation to the erosion of household income tells the story we must tell: .”The American Middle Class Is Losing Ground! In 2014, the median income of these households was 4% less than in 2000. Moreover, because of the housing market crisis and the Great Recession of 2007-09, their median wealth (assets minus debts) fell by 28% from 2001 to 2013. (Pew Research Center)
So, even as our households are losing income security, the cost of healthcare continues to add to this insecurity!
And in the last few days, here are other disturbing trends:
- Major health insurers Aetna and United Healthcare are pulling out of the public exchanges for 2017, *broadly reported in the news media
- Accountable Care Organizations are not showing much in the way of cost savings *JAMA, August 16, 2016
- The Henry J. Kaiser Family Foundation tells us that the marketplace premiums under the Affordable Care Act (ACA), already a subject of perennial interest, have gained even more attention amid unfavorable financial results from some insurers, as well as initial reports of steep premium increases requested for 2017.
What to do?
Where are our priorities?
Dr. Berwick tells us: “To make system-wide progress, leaders will have to establish and sustain a culture of safety in the face of a dizzying array of competing priorities—mergers, bundled payments, and cost-cutting among them. Inconsistent attention to the problem by hospital executives, clinical leaders, and boards of trustees is one big impediment to preventing medical injury today, Berwick said. “This is going to have to become and remain a strategic imperative over time, endlessly forever,” he added. “It’s not something you can take your eye off.” JAMA, August 16, 2016
Let’s add that it is in the transformation of the workplace where learning drives execution, and where quality determines value. Each cost saving, each life saved begins with the very human and humble collaborative efforts of our caregivers. Our relentless commitment to saving lives and reducing cost must begin with the systemic fostering of that collaboration.
Endlessly, forever.
Work and the Future 