Last week, in a scorecard rating the most expensive health care in the world, the Commonwealth Fund said the U.S. isn't getting its money's worth.
Last month, a respected health researcher and academician said it's getting difficult to be a competent physician in this country without technical support.
The two reports are not unrelated.
David Mechanic, director of the Institute for Health, Health Care Policy and Aging Research at Rutgers University, argued in the health policy journal Milbank Quarterly last month that physicians who don't use IT might not be performing to professional standards.
Asked how his assessment related to the Commonwealth Fund scorecard last week showing that the U.S. health system is falling short in several areas, Mechanic said, "There is, of course, a link in that IT and [electronic health records] are important tools that will facilitate addressing many of the deficiencies and absurdities of health care in America."
Scorecard Shows U.S. Slipping, Not Gaining
In its first scorecard comparing the U.S. system with others in the world two years ago, the Commonwealth Fund found that the U.S. fell short of benchmarks for access, quality, efficiency, and other key measures of health system performance. The 2008 scorecard paints an even bleaker picture. The U.S. earned an average of 65 out of a possible 100 points across 37 indicators this year -- slightly below the overall score in 2006.
"We now have 75 million Americans who are uninsured or underinsured," Karen Davis, president of the Commonwealth Fund, said, adding, "Poor access pulls down quality and drives up costs of care. The U.S. leads the world on health care spending -- we should expect a far better return on our investment."
The U.S. spends more than twice as much per capita on health care as most other industrialized countries, but it has fallen to last place among those countries in being able to prevent deaths with timely and effective medical care, according to the Commonwealth Fund report.
The report attributes part of the high costs in the U.S. to the lack of computerized systems linking various segments of the health care industry -- doctors' offices, hospitals, pharmacies and insurers. The report also contends that lack of IT infrastructure makes it harder for the system to improve.
"The continued failure to adopt interoperable health information technology makes it difficult to generate the information necessary to document performance and monitor improvement efforts," the report says.
Mechanic Explores 'Erosion of Professionalism'
In his Milbank Quarterly article, "Rethinking Medical Professionalism: The Role of Information Technology and Practice Innovations," Mechanic writes:
"Physician leaders and the public have become increasingly concerned about the erosion of medical professionalism. Changes in the organization, economics and technology of medical care have made it difficult to maintain competence, meet patients' expectations, escape serious conflicts of interest, and distribute finite resources fairly. Information technology, electronic health records, improved models of disease management, and new ways of relating to and sharing responsibility for patients' care can contribute to both professionalism and quality of care."
Mechanic, a member of the National Academy of Sciences, the American Academy of Arts and Sciences and the Institute of Medicine, said the increasing demands of patient care and ongoing increases in medical knowledge make it difficult for doctors to provide care that is "fair, economical and aligned with the best practices." Efficiencies offered by health IT not only can help but are becoming essential, Mechanic said.
In his 2006 book, "The Truth about Health Care: Why Reform Is Not Working in America," Mechanic outlines several problems also highlighted in this year's Commonwealth Fund scorecard.
He wrote about a growing lack of trust in the health care industry:
"The erosion of trust in part reflects the reality of an increasingly competitive marketplace. The public is better educated than ever before, and rightfully more skeptical of authoritative claims."
As the rest of the culture moves more quickly into the digital age, that lack of trust in health care may be exacerbated as an increasingly wired population wonders about the health care industry's inability or unwillingness to adopt new technology.
Reaching Similar Conclusions
The Commonwealth Fund scorecard ends with a recommendation to pursue several strategies including:
- Universal and well-designed coverage that ensures affordable access and continuity of care, with low administrative costs;
- Incentives aligned to promote higher quality and more efficient care;
- Care designed and organized around the patient, not providers or insurers; and
- Widespread implementation of health IT with information exchange.
Mechanic ends his book with similar sentiment:
"At some point, we as a nation will have to decide whether we wish to design our health care system primarily to satisfy those who profit from it or to protect the health and welfare of all Americans ... anything is possible if the public begins to appreciate how little it gets for what it really pays."