Sunday, November 9, 2008

Best Care Anywhere, part 5: "patient for life"

I started this series a month ago. The most recent post, about the "Hard Hat" code hackers, was here. I finished the book two weeks ago, and on Monday 10/27 I met the author. It's a short, easy read, packed with information and well written - and a great story. I've had a busy two weeks (more on that later)

On the e-patient blog there's a discussion about referrals and second opinions and the difficulties they cause. A whole bunch of patients are really irked at how they're being treated, and I think this is a good thing; I think in the coming year or two we'll see an eruption of people saying how poorly the system works, which could be the start of a long-overdue revolution.

The discussion led me to add a comment based on something important that I found in the book. For your consideration:


I think the time has come to shift the focus for a moment.

A couple of weeks ago I spoke at a dinner along with Phillip Longman, author of Best Care Anywhere: Why VA Health Care Is Better Than Yours. It's a gripping story spanning thirty years, in a book that's just 136 pages long and could be read on a Saturday. I've been "synposizing" it on my blog, starting here.

There are many factors in the VA's success in quality measures and patient safety, but a central one is that they had a patient for life, so there was every incentive for early detection and no incentive to hope the problem would move to a different insurer. So the VA got very good at it, resulting in far less critical care, more effective automation, fewer errors and better care.

I say "had" a patient for life because under the Bush administration, for some insane reason, they changed that rule, totally dissing our veterans by making them prove a problem was service-related.

One might think this was to cut government costs, but the insane thing is that veterans in this bind are then forced to move to Medicare (private medicine), where care is worse and government costs are higher!

The inevitable result is a lengthy appeals process and lawsuits as veterans try to get their case covered, further increasing costs and stressing the veterans and their families. Insane.

Anyway: if our insurers "had us for life," I think they might have greater interest in catching things early and being sure they had the right diagnosis in the first place.

Thoughts, anyone?

1 comment:

  1. Dave,

    Please check in on the Kibbe debate on thcb. I am curious about your perspective, and HELP! Where are the patients?


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