Bad medicine: Health care can cause harm when focus is on providing services instead of improving health

July 1, 2009

Are individuals, families, communities and employers getting their money's worth from US healthcare? That's the big question in the news today, pushed further into the spotlight by the Obama administration.

Charles M. Kilo, MD, MPH, CEO of GreenField Health in Portland, Oregon, and co-author Eric B. Larson, MD, MPH of Group Health Cooperative in Seattle, Washington, explore this important question in their article Exploring the Harmful Effects of Healthcare in the July 1 issue of the Journal of American Medical Association (JAMA).

In their commentary, Drs. Kilo and Larson distinguish health from healthcare. One can never have too much health, but with overuse of medicine, one can get so much healthcare that it causes harm. They look at the potential harms of healthcare, both direct and indirect, and suggest that investigators study health harm further. "Although healthcare's objective should be to improve health, its primary emphasis has been on producing services," they write. "Fee-for-service" payment encourages using more treatment, new technology, and extra testing. These additional services, and their attendant extra costs, may harm health.

Drs. Kilo and Larson lay out the aggregate collective harm that healthcare does to our communities. The cost pressure that healthcare places on employers, individuals and families has become so significant that they suggest that healthcare may well be inducing aggregate harm to the health of our communities when one considers the cost shift involved in funding healthcare.

In addition to direct harm from healthcare, which includes adverse physical and emotional effects, they address indirect harm from the collateral effect of the opportunity cost of healthcare spending. That means healthcare expenditures increasingly divert resources away from education, jobs, and environmental quality, all important determinants of health. They conclude that formally exploring health harm will allow a more explicit consideration of the tradeoffs involved in healthcare interventions and expenditures and will help guide healthcare reform efforts. They argue that although it is important to give more people access to healthcare, that is not enough. Healthcare reform should also improve how medicine is practiced: centering it on patients, organizing it around primary care, and curbing health harm, including excessive healthcare use and spending.

Source: Group Health Cooperative Center for Studies

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jcrow
3.7 / 5 (3) Jul 01, 2009
Also it is more rewarding for the industry to treat an illness vs cure it. More visits and a lifetime of prescription drugs.
There needs to be way more focus on the American diet. The chemical concoctions that somehow qualify as food are making people fat and diabetic.
Doug_Huffman
2.5 / 5 (2) Jul 01, 2009
A surprisingly small fraction of illnesses can be cured.

Prescriptive statements cannot be falsified.
iknow
3.4 / 5 (5) Jul 01, 2009
agreed jcrow... most only care about the bottom line anyway... its called Capitalism. Yanks made sure that some private companies can make billions by charging an arm and a leg for a minor cut.

Of course if you can pay... you're laughing... if you can't ... well, who the hell cares anyway u poor sod... this is the American Dream.

As for US diets... how is it that no one is literate enough to read all the E numbers and actually know they are artificial and not good for you?
freethinking
2 / 5 (4) Jul 01, 2009
iknow, if you charge an arm and a leg to fix a minor cut, my friend over there is willing to do it cheaper and better, Ill go there and you go out of business. Thats Capitalism. However if the government is the only one allowed to fix your cut, your cut will fester and you die. Thats Socialism.

I also live in the US and I choose to eat good food and exercise. I like the information on food packaging, and feel more people should read them and understand them to eat better, but that is their choice.

Im also exposed to a lot of alternative practioners of medicine. Most of them are more in it for the money than for the patient. They say they care for the patient, but they really care for the patients money more than any MD that I know.
DozerIAm
1 / 5 (2) Jul 01, 2009
Everyone complains about the cost of healthcare, but it sure beats not having it, or not having the quality of it we enjoy, or the ready access to it. Remember that there is a cost to having poor quality healthcare and there is a cost to having to wait for healthcare, too.

In the US healthcare may cost more than in some other countries, but in the US you can more quickly get scheduled for a CAT scan or an MRI, you can more quickly get scheduled for surgery or for an office appointment. This is probably why when the rich in Canada or the UK get really sick, they come to the US for their medical needs.

iknow and jcrow, I hear you complaining but I don't hear you suggesting an improved system. Pony up or clam up, mates!
Nan2
3 / 5 (2) Jul 01, 2009
There is PLENTY broken with our health care system, particularly massive incentives which lead to inadequate care for those most in need (can't get a CAT scan w/o insurance as its cost prohibitive). Education of patients very necessary for good outcomes, due to staffing shortage and time shortages, horribly lacking and therefore the confusion among the lay who must try and navigate a system which is complex and counter-productive clinically and administratively.

Standard care is not excessive care, public health isn't valued and therefore isn't funded, staffing is inadequate. The most vulnerable are the ones most often left out of this 'system' altogether. We can't call ourselves a civilized society when our most vulnerable of citizens are abandoned. Witness those who suffer intractable mental illnesses who either live on the street or in jail as there is no place for them, no place.

Market incentives have led to manipulation of well worn scientific methods in bringing treatments to classes of patients, infiltrated those firewalls of protection for those who don't have a PhD to determine if a new class of drug is dangerous or effective, assess if an older drug is just as effective (and cheaper-sometimes more effective) than the latest and greatest newly patented and mass marketed pharmaceuticals to those who have no foundation in understanding the risk, hazards vs benefits or even if it is applicable to them. Its outrageous and must stop. Sell drugs for serious condition on fear is unethical at best.

Time for fresh thinking and for the those who have participated in usury, profiteering in the extreme, breeches of contracts in the insurance world, the billions wasted on fraud on a patchwork quit of billing services to be removed until a more effective means of oversight can be produced. This will take time and the use of professionals who provide care as part of that process rather than than lawyers who are writing laws for lawyers and their golfing buddies with no interest but their own and their next quarterly profits in mind.

The US media rarely reports of the suffering which is PROFOUND in this nation as a result of this so called health system. Therefore the opinions of others are based not on experience but some murky idea of free enterprise or faddish next good or bad health movement slavish followed until the next one comes around that disproves the first one on some small sample study.

Remember, those ad revenues from pharma pay the bills of those who are the last defense in a free nation. That of an independent and free press who can produce investigative journalism beyond heavily editorialized 1 minute spots. That was lost long ago, mega media is worthless now.

An improved system would allow for a single-payer system that would standardize billing. That ALONE would save $300Billion a year! Insurance companies can provide 'luxury' services for those who can afford it. Taking out the incentives of those who have clearly abused the system, whose education does not include "first do no harm" in management of hospitals and clinics mandatory. Clinics to provide routine and standard care will save money, not the opposite. A gigantic base will allow for negotiation of costs from drugs to supplies just as other such systems have. If no one believes those never ending drugs ads aren't paid by you and me somehow then, take off your blinders. By providing routine followup care to those with incurable and chronic conditions it saves money because then rather than a small problem not being treated early because the patient can't afford it, it reaches a crisis proportion requiring hospitalization and even more intense and complicated care over the long term.

What we have now is counter-productive in a business sense and unethical otherwise.

ShotmanMaslo
2 / 5 (4) Jul 01, 2009
freethinking "iknow, if you charge an arm and a leg to fix a minor cut, my friend over there is willing to do it cheaper and better, Ill go there and you go out of business. Thats Capitalism. However if the government is the only one allowed to fix your cut, your cut will fester and you die. Thats Socialism."



..or if you dont have enough money, you die. Thats Capitalism, too.

Conclusion? A hybrid system provides the best of both worlds. Basic healthcare is mostly payed from our taxes (but you have to see a doc for example once a year for checkout), and better, quicker healthcare or not so serious problems are payed by yourself.
..and thats social democracy!
freethinking
1.7 / 5 (6) Jul 01, 2009
In a Socialist country, the government decides that you dont get anymore care, you die.

Ive lived in Canada and the system has many failures. Im living in the US and see the system has many failures. Which do I prefer? The US. I can see the doctor whenever I want to.

So, how can the US system be made better? Lets come up with some ideas we can all agree.
1. Only people legally here can use any "free" or subsidized healthcare.
2. Allow insurance companies to market across state lines.
3. Get rid of any mandates.
4. have the governement provide a barebones only, low cost health care. (only fixes things that need immediate attention)
5. tort reform.

any other ideas?
DozerIAm
1 / 5 (1) Jul 06, 2009
Freethinking, #4 is already in place. Anyone can stroll, limp or be carried into any US emergency room and get whatever lifesaving treatment is needed, whether they are insured or not.

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