U.S. health­care fail­ing in cost, qual­ity, safety; to­gether we can cure what's ail­ing our sys­tem

Modern Healthcare - - COMMENT - By Dr. Robert Pearl In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at mod­ern­health­care.com/op-ed. Send drafts to As­sis­tant Man­ag­ing Edi­tor David May at dmay@mod­ern­health­care.com.

The Amer­i­can health­care sys­tem is headed to­ward a cliff, and the fall will be long and painful. Health­care con­sumes 18% of our na­tion's gross do­mes­tic prod­uct, al­most 50% more than the sec­ond high­est-spend­ing na­tion. High-de­ductible health plans are the new norm for one-third of in­sured pa­tients. Out-of-pocket costs are in­creas­ingly un­af­ford­able for many.

Health­care ac­counts for 40% of tax rev­enue, and with 10,000 baby boomers be­com­ing Medi­care-el­i­gi­ble each day, Amer­i­can health­care is head­ing for a fi­nan­cial free fall.

There are plenty of rea­sons for our coun­try to fear these ris­ing costs, but qual­ity prob­lems and per­sonal in­con­ve­nience are just as wor­ri­some for pa­tients. Nearly a half-mil­lion Amer­i­cans die un­nec­es­sar­ily each year from a com­bi­na­tion of avoid­able med­i­cal er­rors, fail­ure to re­ceive the rec­om­mended pre­ven­tive ser­vices, and dis­par­i­ties in health out­comes be­cause of race and other so­cial de­ter­mi­nants of health.

Mean­while, few peo­ple can ac­cess the same tech­no­log­i­cal con­ve­niences in their med­i­cal care that they de­mand from the bank­ing, travel and re­tail in­dus­tries. Over­all, U.S. health­care scores in the bot­tom half on nearly all mea­sures of qual­ity when com­pared with the other 20 most-in­dus­tri­al­ized coun­tries in the world.

To ad­dress these prob­lems and help pa­tients un­der­stand the im­pact on their health, I wrote Mis­treated: Why We Think We’re Get­ting Good Health Care—and Why We’re Usu­ally Wrong.

It be­gins with the story of my fa­ther, who died, in part, from med­i­cal er­ror and the fail­ure of his doc­tors to ef­fec­tively com­mu­ni­cate with one another.

Af­ter his death, when­ever I spoke pub­licly about my fa­ther's mis­treat­ment, peo­ple would line up to share sim­i­lar ex­pe­ri­ences about the care of their loved ones. The com­bi­na­tion of my de­sire to trans­form Amer­i­can medicine and my fam­ily's per­sonal ex­pe­ri­ence has led me to do­nate all prof­its from the book to char­ity to help pro­vide ac­cess to those un­able to ob­tain nec­es­sary care to­day.

As CEO of the na­tion's largest med­i­cal group and as the son of a man who died pre­ma­turely, I set out in

Mis­treated to ex­plore the strange divi­sion be­tween the ob­jec­tive data on the qual­ity of Amer­i­can medicine and the all-too-preva­lent be­lief that Amer­i­can medicine is the best in the world, even if high-priced. By ex­am­in­ing decades of psy­cho­log­i­cal lit­er­a­ture, be­hav­ioral eco­nomics and the most re­cent brain scan re­search, I came to un­der­stand why pa­tients ac­cept so much less from their health­care than they de­mand in other ar­eas of their lives. The an­swer re­sides in the power of per­cep­tion.

Stud­ies show that un­der the right cir­cum­stances, our brains un­dergo a neu­ro­bi­o­log­i­cal shift, caus­ing us to per­ceive the world in ways that con­tra­dict ob­jec­tive re­al­ity. This sub­con­scious dis­tor­tion pro­duces be­hav­iors that prove prob­lem­atic. Nowhere is this more ev­i­dent than in the world of health­care. We see in­ter­ven­tion as more im­por­tant than pre­ven- tion, over­look omis­sions in pre­ven­tive ser­vices and tol­er­ate med­i­cal er­ror. And fear makes most pa­tients re­luc­tant to ques­tion the rec­om­men­da­tions of physi­cians, or even in­sist that they wash their hands be­tween hospi­tal rooms.

As health­care edges closer to the prover­bial cliff, pa­tients and doc­tors are faced with a painful choice. Ei­ther we trans­form the U.S. sys­tem or watch it de­volve into a two-tier sys­tem of care, di­vided be­tween the rich and ev­ery­one else. To avoid this pit­fall, Mis­treated pro­vides a road map for the fu­ture with real-life ex­am­ples of what is achiev­able in health­care with the proper struc­ture, fi­nanc­ing, tech­nol­ogy and lead­er­ship. When med­i­cal care is in­te­grated within and across spe­cial­ties, cap­i­tated at the de­liv­ery sys­tem level, sup­ported by the most mod­ern tech­nol­ogy and physi­cian led, su­pe­rior out­comes can be achieved.

My hope and be­lief is that if enough Amer­i­cans un­der­stand the short­com­ings of the cur­rent sys­tem and de­mand that all physi­cians and hos­pi­tals match the top per­form­ers to­day, our per­cep­tions will change. We can then trans­form Amer­i­can medicine from the out­dated cot­tage in­dus­try it re­sem­bles to­day. If we do, and if hun­dreds of thou­sands of lives are saved each year, then my fa­ther's death will have served a pur­pose.

Dr. Robert Pearl is ex­ec­u­tive direc­tor and CEO of the Per­ma­nente Med­i­cal Group and pres­i­dent and CEO of the Mid-At­lantic Per­ma­nente Med­i­cal Group.

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