Two trillion dollars. Perhaps over two trillion dollars.That is what we spend every year on health care in the US. Almost
seven thousand dollars for each person. Twenty eight thousand dollars for a family of four. And each year the amount goes
up. Individuals see deductibles and co pays consume a larger part of their income, corporations see medical costs exceed profits
and governments see deficits grow. In return most of us have access to the most technologically sophisticated medical care
in the world. Tests, procedures and medications not available a decade ago have become commonplace. In fact, more people are
living longer than ever before. Perhaps we should celebrate.
However, there is a great disparity in the way care
is delivered from one local to another, from one hospital to another, from one physician to another. A study comparing outcomes
and costs for nearly one million Medicare enrollees published in the Annals of Internal Medicine found that residents in high
cost regions received 60% more care than those in low cost regions. Yet the health outcomes were similar. Overall barely one
half of physicians routinely follow best practice guidelines. And for some chronic diseases such as diabetes that number is
far less than half.
The chances of recurrence in hernia operations are one in ten for some surgeons, one in twenty
for others but less than one in five hundred for a select few. A study in Scotland of patients with treatable colon cancer
found that the ten-year survival rate varied from as high as sixty-three per cent to as low as twenty per cent, depending
on the surgeon. For coronary bypass, after adjusting for underlying risk factors, death rates in New York vary from five per
cent to under one per cent. In London, England, the rate of completion for colonoscopies averaged only 67% but for physicians
in academic centers it was over 90%.
These examples are neither isolated nor extreme. They are simply what were found
when someone took the time to investigate. To investigate AND measure outcomes. But even more compelling, the vast majority
of physicians do not know this information about themselves leading to what we call, вЂthe disconnect between physicians
and their outcomes over time’.
So where are we now? Huge medical expenditures give most of us access to highly advanced
and sophisticated medical care but without any meaningful measure of how well we are doing or, especially, how well we could
do. For over twenty years medical costs have been an issue. And for over twenty years attempts to control these costs have