This blog briefly analyzes of the access to healthcare and innovations that are occurring in America.
The Dartmouth Atlas Project went on for 20 years to evaluate hospitals and physicians in various regions. Their research has lead to the improvement in healthcare efficiency and effectiveness. (http://www.dartmouthatlas.org/tools/)
Whether healthcare is a right or a privilege is at the centre of the healthcare debate in America. According to the Universal Declaration of Human Rights as agreed upon by the United Nations, Article 25 states: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care…” (http://www.un.org/en/documents/udhr/) By that definition healthcare is a right but what is at issue is the definition of “adequate” care. In the United States no emergency room is allowed to turn away any patient regardless of their ability to pay. In Canada, all healthcare is covered by the government, with exceptions of some prescriptions. However if we look at the Democratic Republic of Congo (DRC), their version of healthcare, by our standards, is horrendous. Even though we from the West are less than impressed (to put it politely) with their healthcare, the locals are happy with it – it is better than having none. To be blunt, no matter how bad we think the healthcare that the poor here receive, it is amazing compared to the standards of “adequate” care elsewhere.
There were various innovations that are being done within the system. I like how doctors have to answer emails and phone calls, despite the fact that they do not get paid to do so. That along with planning with patients and using computers to easily look at a patient’s history makes patient care very individualized. Doctors may have to spend more time with their patients but in the long run, the system will make doctor visits more productive and will be more efficient. Cost-cutting is also very helpful for patients.
An interesting innovation is shared-decision making. While I agree that the patient must have a voice in their treatment, sometimes the patient does not fully understand what is occurring. Despite explaining and doing research on the issues, patients may not get it. My friend, “Amanda”, and her family have spent countless hours researching epilepsy: treatments, side-effects, consequences and possibilities that could improve her situation. Despite this, her neurologist knows that ‘x’ will not work because of what he has seen with numerous of his patients. Also, medications list a lot of side-effects (in case the manufacturer is sued) but very few of them are important/common. Obviously a doctor is not going to do something without the patients consent but sometimes it is best to listen to the doctor’s advice. If you do not want his advice, you can always diagnose and treat yourself.
To a certain extent the medical system innovations discussed on the program are similar to aspects of healthcare in Canada. The innovations that are not in effect in Canada are very unlikely to be implemented. There are no incentives for the Canadian doctors to change their practice. There is a serious shortage of doctors, thus there is no difficulty getting/keeping patients. Since there is such a demand for doctors, there is no reason for there to be any change in the system. The demand for doctors is so high that they even recruit doctors in the Democratic Republic of Congo to work in Canada!
Kat,
ReplyDeleteI found this blog very interesting! I especially enjoyed how you put your own opinion into the video. Specifically, your personal experience with "Amanda" has given you a very qualified expression of how much patients should be able to decide for themselves what treatments they should receive. I think educating the patient (as the doctors at Dartmouth did) is the best way to eliminate these issues. All in all I do agree that the doctors know best, they did go to school for a decade to know such!
Kat,
ReplyDeleteNice blog! I found your opinion on shared-decision making very interesting. I agree with you that most of the time we should listen to the people who went to medical school and are actually trained. However, I think it would be rather empowering to have the opportunity to make some of the minor decisions for myself. Also, you seem to have a strong feeling for the healthcare system in Canada. Do you see yourself returning there for your career?
Kat,
ReplyDeleteThank you for your blog - I can tell that this is an issue that you have thought about quite a bit. I really liked your paragraph on healthcare as a right - you did a very nice job in highlighting its recognition as such on the world stage through the UN Declaration, but also the various extents to which that is or is not being fulfilled in different countries. What do YOU think about this issue? Is access to healthcare a human right?
The Dartmouth Atlas, as you said, is a long-term ongoing project whose results have lead to improvements in healthcare efficiency, partially by simply highlighting those already performing better than others. Specifically, it is a project that studies the differences in Medicare spending nationwide. It has found surprisingly large variations in billing and treatment from place to place even in places with similar demographics. Its data found that supply drives demand, which is troubling but not so surprising to me - what do you think about this?
Some of the innovative healthcare experimental designs gone over in the video could help to remedy this. You mentioned the utilization of technology in medicine (phone calls, computers/emails, etc), cost-cutting in general, and shared decision making. I agree with you that all of these interventions could help to decrease costs and improve care. Your point on shared decision making is well-taken, that sometimes despite much research the patient still isn't able to assess the full set of information in the same way that a doctor will. But the point of this approach is that the doctor first explains his or her perspective including his or her opinions/experience on the topic to the patient. Armed with this information, the patient can then make a more informed decision.
What were some of the other types of innovations that the video highlighted? I was also curious, how can someone diagnose and treat themselves? Can people get prescriptions in Canada without a doctor writing them?
Finally, you mention that the innovations seen in the video are similar to the ones already implemented in Canada, but then say that those innovations not already implemented there are unlikely to be. (Which innovations are you talking about specifically?) I do agree that unfortunately when financial incentives aren't used, and when there is such a demand in the system for doctors, that changes are less likely to occur. But perhaps some of these changes that make care more efficient could decrease the need for doctors, easing the effects of the shortage. What do you think?
Overall, you did a good job on this blog. Just try to read every question - the 3rd question asked for at least one specific innovation from each specific sites highlighted in the video. Good job and interesting commentary - I look forward to reading more!