Tag Archives: mortality rate

Why U.S. Healthcare Is So Mediocre

In my capacity as benefits consultant, I often hear employees say they know we have the most expensive system in the world, but they feel that is a fair trade-off because we have the U.S. healthcare system is the best in the world.

Well, let me disavow you of that notion. Every metric measurable shows that we have a mediocre system, at best! The World Health Organization ranks the U.S. healthcare system as 37th in the world, strictly based on outcomes. That puts us tied with Slovenia but significantly behind Costa Rica, Saudi Arabia, Colombia and the bankrupt country of Greece.

Part of the reason for the poor results, I believe, is because we don’t ask hard questions on the quality of care we receive (and likely wouldn’t get answers, if we did). Does anyone know the readmission rate or infection rate of the hospital they are about to have a surgical procedure in?

Stephen Dubner of Freakonomics fame asked the following question: There are two major cardiology conferences each year, where more than 7,000 of the top cardiologists and thoracic surgeons go for one to two weeks each; what happens to the quality of care in their facilities while they are gone?

I tried to imagine: Would I want to even go to the hospital knowing the top doctors were away?

To get to the answer on quality of care, Dubner used 10 years of data from Medicare looking at more than 10,000 patients with emergency types of heart conditions (like heart attacks) so that patient choice of facility is largely removed as a variable. The baseline for the comparison against the work of these top doctors was data from teaching hospitals, even though conventional wisdom says, “Take me to the facility with the top doctors and keep me away from a teaching hospital. I don’t want any residents cutting their teeth on me!”

The answer: If you were brought to a teaching hospital for a heart attack, your mortality rate was about 15%. Mortality rate at a non-teaching hospital, with those top doctors, the week before or week after the convention was 25%! This is a HUGE swing! This means that, for every 100 heart attacks brought in, 10 more people die when the top doctors are around!

Let me put this in perspective. If you look at all treatments given for a heart attack, like beta blockers, Plavix, stents, angioplasty, aspirin….all these COMBINED reduce mortality by 2% to 3%!

Here is another interesting point. The amount of invasive treatments, like angioplasty and stents, are used in about 33% FEWER cases when the cardiologists are away.

Okay, so wait a second. Did I just say that better care is given when the top doctors are away, and, at the same time, less severe treatments are being administered and fewer dollars are being spent?

That sounds pretty counter-intuitive. Let me give my take on why.

When I think of a “top” cardiologist, an image comes to mind. He has lots of gray hair (not sure why my mind imagines a male, but it does), and has been doing cardiac surgery for decades. Does this sound about right?

Well, this doctor was trained in medical techniques 30 or 40 years ago, and he has likely been sued for malpractice, perhaps multiple times (which leads to “defensive” medicine). He frequently has ownership or at least compensation tied to the profitability of the facility where he practices. These traits lead to more care and often inappropriate (or unnecessary) care. The younger doctors, meanwhile, are less jaded by malpractice, less engaged in profits and more recently trained.

I ask you to question EVERYTHING when it relates to care. Assume nothing. One thing is clear; the more involved the patient is in her own care, the better the outcomes (and the lower the costs, too)!

Implementing International Medical Providers Into The U.S. Workers' Compensation System, Part 2

This is Part 2 of a multi-part series on legal barriers to implementing international providers into Medical Provider Networks for workers' compensation. Part 1 of the series can be found here, and Part 3 can be found here. Subsequent articles in the series will be forthcoming soon.

Quality and Medical Tourism
Considerations of cost are one reason why patients go abroad for medical treatment. Patients also seek medical care abroad for the quality of care received at foreign hospitals, which is the primary concern of medical tourism critics.13 Fears of poor quality result from stereotypes regarding doctors and facilities in developing countries.14 The quality of care available at many of the common medical tourism destinations are comparable to that available to the average U.S. patient; also death rates and adverse outcomes for cardiac patients in Indian and Thai medical tourist hospitals are comparable to, and in some instances, lower than those at American hospitals.15

Typically, the effectiveness and safety of health care services delivered to patient populations in the U.S. is how “quality of care” is measured. However, quality is generally difficult to measure or define.16 Also, comparing safety on a state or local level is practically impossible.17 Federal policy makes reporting adverse events at medical facilities voluntary, and few states require reports to be made public.18 Reports, where made, are usually incomplete as well.19

Apollo Hospital Group and Wockhardt Hospitals in India (affiliated with Harvard Medical School), and Bumrungrad International Hospital in Bangkok, provide a better level of care than most community hospitals in the U.S., according to Harvard Medical International, Inc. (now Partners Harvard Medical International).20 21 For at least one common procedure performed in the U.S. today, coronary artery bypass graft (CABG), the mortality rate for Apollo Hospital Group and Wockhardt Hospitals is less than 1%, whereas in several California hospitals, the mortality rate ranged from 2.1% to 13.8%.22

The disclosure of recognized quality indicators, oftentimes not done in the U.S., is true for many hospitals overseas.23 24 However, those hospitals that compete on an international level do disclose quality indicators.25 26 U.S.-based hospitals such as Dartmouth Hitchcock Medical Center in New Hampshire and Cleveland Clinic in Ohio post quality indicators on their hospital websites.27 28 National University Hospital in Singapore discloses information that their quality compares favorably internationally.29 30 The Apollo Hospital Group in India, has devised a clinical excellence model to ensure its quality meets international health standards in all of their hospitals;31 32 other Indian hospitals are creating standards for reporting performance measures.33 34

Perhaps the best example of this is Bumrungrad International Hospital in Thailand. Bumrungrad is a modern multispecialty hospital with 554 beds. Its main building was built in 1997 to conform to U.S. building and hospital standards. Bumrungrad tracks more than 500 quality and patient safety measures.35 Over 100 of their doctors are board-certified by U.S. medical specialty groups, as they have been trained in the U.S. or the U.K.36 37 Many of them have licenses from Australia, Europe and Japan.38 Bumrungrad is also accredited by the Joint Commission International.39

The establishment of the Joint Commission International (JCI), the international arm of the Joint Commission, has meant that the quality of hospitals overseas has been assessed by the Commission and that the health care offered at those hospitals conforms to “international quality.” Countries such as Thailand and India recognize the value of standardization and certification, and have established their own national accreditation bodies.40 Therefore, the issue of quality of care at international hospitals that cater to medical tourism should not be a major factor, and will only improve as more nations comply with international standards, and their hospitals are equipped with the latest technology and most-highly skilled and trained medical providers.

Additionally, medical tourism will relieve the critical shortages in medical staff for physicians, specialists and nurses. In 2000, the demand for registered nurses exceeded the supply by more than 100,000, and by 2020 this shortage will increase to more than 200%.41 And as the Affordable Care Act kicks in in the next few years, the demand for services as more individuals are covered will put considerable strain on an already strapped health care system. This will affect quality in U.S. hospitals as the shortages become more acute.

Putting the issue of quality aside, another fact to consider is the number of people participating in medical tourism. An estimated 500,000 Americans traveled abroad for treatment in 2005, the majority of them to Mexico and other Latin American countries. Americans were among the 250,000 foreign patients seeking care in Singapore, 500,000 in India, and as many as 1 million in Thailand. The impact of these numbers is considerable as medical tourism grossed approximately $60 billion worldwide in 2006, and was estimated to rise to $100 billion in 2010.42 Medical tourism is growing very rapidly and is expected to grow even more so in the coming decade.

13 Heather T. Williams, “Fighting Fire with Fire: Reforming the Health Care System Through a Market-Based Approach to Medical Tourism,” North Carolina Law Review, 29 (2011): 627.

14 Ibid, 628.

15 Ibid, 628.

16 Ibid, 628.

17 Ibid, 629.

18 Ibid, 629.

19 Ibid, 629.

20 Devon M. Herrick, “Medical Tourism: Global Competition in Health Care”, (NCPA Policy Report No, 304, Dallas, Texas, 2007), 14.

21 Toro Longe, “The Ethical and Legal Complexity of Medical Tourism: Questions of International Justice, Economic Redistribution and Health Care Reform,” (master's thesis, Loyola University of Chicago, 2010), 9.

22 Herrick, 13, Cardiac Surgery Mortality Chart, Figure IV.

23 Ibid, 14.

24 Longe, 10.

25 Herrick, 14.

26 Longe, 10.

27 Herrick, 14.

28 Longe, 10.

29 Herrick, 16.

30 Longe, 10.

31 Herrick, 16.

32 Longe, 10.

33 Herrick, 16.

34 Longe, 10.

35 Ibid, 9.

36 Boyle, 44.

37 Longe, 9.

38 Ibid, 9.

39 Ibid, 9.

40 Leigh Turner, “'First World Health Care at Third World Prices': Globalization, Bioethics and Medical Tourism”, BioSocieties 2, (2007): 311.

41 Williams, 627.

42 Herrick, Executive Summary.