| "SELECTED QUOTES FROM STUDENTS ATTENDING CLASSES TAUGHT BY PROFESSOR TOR DAHL" |
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Quotes from Students Papers
2006 |
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Constraints need to be created in P4P programs to ensure cases that tend to have poorer outcomes, such as non-compliant patients and the poor, will not be passed over by some physicians when payment is tied to outcomes. It is foreseeable that access to care for some patients will decrease under poorly structured P4P models. — Travis Gathright, Pay for Performance Pitfalls ----------------------- “A secret Harris Poll showed that consumers can guess the price of a Honda Accord within $300, but when asked to guess the price of a four day hospital stay they were off by $8,100 (Goodman, 2006).” “In 2004, the American Hospital Association reported that the average hospitals were paid 38% of their charges (2005).” “Simple-Care, a retired physician group, who collects cash up front, began posting rates of common procedures … The price for an MRI went from $3,000 to $600 (DoBias, 2001).” — Anna Thompson, Health Care Pricing Transparency ----------------------- Bonnel (2000) estimates that over a twenty-year period, a prevalence rate of 20% of HIV/AIDS would be accompanied by a 67% drop in GDP. — Fandoalo Amegandji, The Implications of Health in the Economic Growth on Developing Countries ----------------------- Around 8 million deaths a year could be avoided from such conditions as HIV/AIDS, malaria, TB and child infectious diseases. In sub-Saharan Africa the economic loss due to HIV/AIDS we estimated to be at least 12% of annual GDP. Sachs tells the story of a family where a little girl had contracted malaria. The mother had to make a 10-km walk to the closest health facility. Upon arriving there, they were told that they were out of quinine and had to return the next day. The little girl survived the night and received treatment the next day, but stories like this can be repeated throughout the developing world. — Victor Gauto, Health and Economic Development ----------------------- “Estimates of the total healthcare costs associated with these non-healthy behaviors alone (tobacco, drugs, alcohol and obesity) account for roughly one third of all health care costs.” “Inequities in the distribution of healthcare (i.e., under the proposed plan) will not be a function of the ‘haves’ and the ‘have nots,’ but rather a function of ‘the dids’ and ‘the did nots’.” — Thomas A. Schmitt, Health Economics ----------------------- [Author] agrees that managed care, “has taught us a fundamental lesson of what we want out of medicine. We are interested not just in cost savings but in health improvement” (2004). “To understand quality improvement, start with a simple observation: You get what you pay for. We want the medical system to improve our health, but we reimburse it for treating us when we are sick. Medical care is not the same as health improvement, and the system does poorly when they differ. A better medical care system would pay for health improvement, rather than for provision of services (Cutler, 2004).” — Carol Backstrom, Quality Recognition Programs: Fad or Silver Bullet? ----------------------- The time spent by patients in a clinic waiting room represents a real cost to them – despite the fact that no financial transaction has take place. The economic concept of cost is based on the awareness that, when resources are used in a certain way, those same resources are not available for use in other activities, and the benefits that would have been derived from those other activities, are sacrificed. — Tracy Radtke, The Economic View of Evidence-Based Medicine ----------------------- [For Profit hospitals] are popular due to the reason that they work well, they increase patient, employee and practitioner satisfaction, lower infection rates and improve the wellbeing of patients. — Shelia Orr, Economics and For-Profit Hospitals ----------------------- “ Better health could improve our country’s annual earnings by 11% to 30%, and would increase educational attainment (Hadley, 2002).” — Amy Kelleher, Health Care Reform in the United States: The Time is Now ----------------------- In 1970, Americans spent about $6 billion on fast food —in 2000 they spent more that $110 billion. Americans now spend more money on fast food than on higher education, personal computers, computer software or new cars (Eric Selosse in Fast Food Maker, 2001). According to the National Heart, Long and Blood Institute, a serving of chicken Caesar Salad 20 years ago would have been about one and a half cups and would have contained about 390 calories. A serving of chicken Caesar salad today would be about three and a half cups and 790 calories that would account for almost forty percent of the recommended daily calories for a 31 year old woman (USDA). — Katie Litsey, We Must Change for the Children: The Economic Costs and Trappings of Our Obesity Culture ----------------------- In the year 2000 37% of the nursing work force comprised Associated Degree (2 year) nurses and in 2006 60% of the Registered Nurse graduates were Associate Degree Nurses (Graf, 2006). These percentages show a dangerous trend in nursing education and US healthcare. Our system currently requires board licensure examinations to determine entry level in the field of Nursing. The examination is a written examination, so it is possible to pass without ever having touched a patient. — Patrick J. Collins, Nursing Shortage Ramifications and Possible Solutions ----------------------- Retail health clinics are staffed by either licensed nurse practitioners or physician assistants. Overhead is extremely low as the clinics are only approximately 140 square feet in size, and are only staffed by the clinician. (Wojire, 2004). This individual is not only responsible for providing medical care, but also for reception, billing and management of the clinic. These clinics are often located in either national pharmacy chains (Walgreens and CVS), grocery stores (Cub Foods and Hy-Vee), or in discount super stores (Wal Mart and Target (MSNBC, 2006). The clinics are open seven days a week and have extended hours into the evening. The other key component for the success of these clinics is the services provided and the prices of those services. Services provided at these clinics are for common illnesses, such as strep throat, bladder infections, sinus infections, and ear infections. Many of the clinics offer evaluation and treatment for these conditions for a price of $45, which is much less what it would cost for a similar service at a physician clinic or an emergency room (Frenckeheim, 2006). To ensure quality and safety for their patients, protocols are in place to ensure that the midlevel practitioner will refer patients for future care. — Robb Gardner, The Impact of Retail Health Clinics on the Future Delivery of Healthcare ----------------------- Today the average life expectancy of one of the world’s 6.5 billion citizens is 67 years and 6 months (CIA World Factbook, 2006). However, the range of life span by member nations of the world varies tremendously, from a low of almost 33 years in Swaziland on the continent of Africa to just above 82 years in the urban Chinese Island State of Macao. Over the course of the last two thousand years, human life expectancy has risen from 7,000 days (less than 20 years) to over 25,000 days (almost 70 years) currently. By 2050, the average life expectancy of the one of the 9.3 billion citizens of the planet will be almost 75 years of age (U.S. Census Bureau, 2002). [The Knowledge Economy} first cited by Peter Drucker in his work The Age of Discontinuity: Guidelines to Our Changing Society (1969), [stated that] the knowledge Economy is built on abundance of resources, not scarcity. This is in diametric opposition to other eras in human history characterized by steep competition for scarce resources (Marx, 1856). Some have argued that the emerging knowledge society generates its wealth through the economic exploitation of understanding (World Bank, 2005). — Michael A. Spine, Electrification, Urbanization and Computerization: Life Expectancy in the Knowledge Age ----------------------- The symptoms of fatigue according to the labor - studies (at the FAA) begin with errors of omission, progress to errors of commission, and finally result in micro sleep (periods of sleep lasting for seconds or minutes). Fatigue is associated with 100,000 motor vehicle accidents per year and 1,500 deaths in the US. It is estimated that in the U.S. fatigue costs around $18 billion in employer productivity loss, and $12.5 billion in personal and property loss. Fatigue (sleepiness, tiredness) is the largest identifiable and preventable cause of accidents in transport operation (between 15% and 20% of all accidents) surpassing that of alcohol and drug related incidents in all modes of transportation. — Jamie Peyton Rodgers, Are Hospitals Encouraging Dangerous Working Conditions for Healthcare Professionals? ----------------------- Economic theory suggests revocation of state-based licensure restrictions would confer cost savings benefits to consumers in addition to anticipated improvement in the efficiency and fluidity of human resources. Research implies those benefits would occur without compromising the quality of care received by consumers. The American Medical Association remains staunchly in support of state-based physician licensure, noting that adoption of a national licensure system has implications beyond the fluidity of providers and lacks the flexibility and ability to respond to local idiosyncrasies. (We’d note that the current system lacks the flexibility to respond to anything). It has been more that 45 years since Milton Friedman’s landmark work, Capitalism & Freedom, was published, launching a new chapter in the on-going debate regarding licensure of medical professionals. Friedman (1962) contended: …licensure has reduced both the quantity and the quality of medical practice forced the public to pay more for less satisfactory medical service, and has retarded technological development both in medicine itself and in the organization of medical practice. Robinson (2001) notes: The Internet threatens to turn much of the system on its head. Patients with serious chronic disease – those responsible for most health care utilization now increasingly have more, not less, information concerning their specific clinical condition than do their treating physicians. Some arrive in the office with a stack of articles downloaded from the clinical journals that the doctor has no time to read, with performance statistics on the services provided by particular providers and facilities, and with support from cybernetworks of fellow sufferers who trade experiences, anecdotes, and Web site references. Obviously, the typical physician will always understand clinical medicine better than the typical patient. But we stand at the beginning of a new era. Jackie Eder Van Hook, Executive Director of the Center for Telemedicine and eHealth Law suggests, “ Thanks to technology, we have the ability to provide access to health care services around the world 24/7, yet we have laws, regulations, and policies that prevent this from occurring” (Center for Telehealth and E-Health Law, 2005). — Kelly James, Physician Licensure in the Information Age: Is State-based Licensure the Best Model for Healthcare Markets? ----------------------- It is eye opening to review the statistics on back injury rates for healthcare workers compared to other industries. Six of the top ten workers at greatest risk for back injury on the job are in the healthcare field – nurse aides, licensed practical nurses, registered nurses, health aides, radiology technicians, and physical therapists (www.premierinc.com). Compared to workers in heavy industry and other occupations that are traditionally considered hazardous, the rate of work-related injuries was 11.4 per 100 in full-time hospital workers, 16.8 per 100 among nursing home workers, and 17.9 per 100 among nurses and nurses aides (Evanhoff et al., 1999). This compares with a rate of 6.3 per 100 full-time workers in the mining industry, 11.8 per 100 in construction, and 12.2 per 100 in the manufacturing industry (US Department of Labor, Bureau of Labor Statistics, 1996). Patient care staff at nursing homes and hospitals are at particular risk for overexertion back injury usually resulting in “back strain” or “back sprain.” These injuries are considered minor and usually have inflammation, muscle spasm, and pain associated with them. They occur when a muscle, tendon, or ligament is forced past its normal range of motion or strength capacity. They usually heal in 24-72 hours with rest, gentle stretching, mild modalities such as ice or hear, and behavior modification – avoiding whatever action caused the injury (www.mayoclinic.com). The problem is that often times injuries such as these are not reported (Tate et. a., 1999). This may be because the symptoms are minor and employees don’t notice a huge difference in how they feel. Regardless, a small strain can turn into a big problem in a short time with repeated causal behavior. The results of repeated risk behavior usually lead to a cycle of inflammation, muscle spasm, and severe pain. When it gets to this stage, medical treatment and rehabilitation are the most viable options. Examples of poor lifting technique and body mechanics include repetitive twisting and bending at the waist, failure to use the legs during lifting, failure to keep the “load” close to one’s own body during the task, pulling instead of pushing, failure to use the abdominal muscles during the task, poor posture during the task, and rushing/poor planning of the lifting task. Richard Lippin, a leader in the field of occupational medicine said, “Face the reality that a very large percentage of illnesses, injuries, and hospitalizations are entirely preventable.” (www.ricklippin.com). Healthcare leaders need to take this message to heart as they begin to implement a comprehensive prevention model into their organizations. The ironic thing is – it will be their own backs they are saving. — Christopher M. Nichols, How Healthcare Administrators Can Save Their Own Skins: The Impact of a Comprehensive Ergonomic and Back Injury Prevention Program for Employees ----------------------- “A long life is no accident” (Buettner, 2005). (McGinnis, 1993; Thorpe, 2005; Institute For the Future, 2005) Thorpe goes on to say, “Much of the growth in health care spending over the past twenty years is linked to modifiable (emphasis supplied) population risk factors such as obesity and -,” (Thorpe, 2005). So, it would go to reason that, by reversing those harmful modifiable life style factors that got us here in the first place, we could then reverse the trends in health care spending. Over the years, analysis of the 10 leading causes of death suggest that approximately 50 percent of U.S. mortality is due to unhealthy behavior or lifestyle; 20 percent to environmental factors; 20 percent to human genetic factory; 10 percent due to inadequacies on health care or access (Fig. 10) (Healthy People, 1979; CDC). In addition, figure 10 shows the proportion of money as a nation we spend on different areas of health care. Is it not ironic that, despite our behaviors affecting 50 percent of our health, we as a country only spend 4 percent of our health care dollars on behavior related activities? The majority of our money (88%) goes to fixing our health after our poor behaviors have damaged it! It is quite evident that the greatest factor that affects our health is our behaviors or lifestyles. Therefore, in order to make the greatest change, when it comes to health, we ought to focus on behavioral changes, rather than access to health care services!
Fraser, 2003; Buettner, 2005). Some of the key findings from the study that accounted for these differences were:
Refocusing Our Efforts – Public Health: The linked concepts of disease prevention and health promotion are certainly not novel. Ancient Chinese texts discussed ways of life to maintain good health – and in classical Greece, the followers of the gods of medicine associated the healing arts not only with the god Aesculapius but with his two daughters, Panacea and Hygeia. While Panacea was involved with medication of the sick, her sister Hygeia was concerned with living wisely and preserving health. (The Surgeon General’s Report On Health Promotion And Disease Prevention, 1979). — Kenneth Rose, M.D., Can Lifestyle Changes “Save” the Health Care System for the Elderly of the Future: The Economics of Health and Longevity----------------------- The PACE program is centered on the belief that it is in the best interest of seniors and their families to receive long-term or chronic care in the community whenever possible (NPA, 2006). Services delivered include all medical and supportive services including physician visits, medications, nursing, home-care, dental, vision, social work services, recreation and social opportunities, and physical, occupation and speech therapies (NPA, 2006). In in-patient hospital and nursing home services are needed the PACE program ensures these services are provided as part of the all-inclusive rate. Many services are provided through a day center and transportation to and from the center are included and are central; to the success of the program (McCommons, 2005). Also key to PACE programs is the capitated rate that combines payments for acute, ambulatory, and long-term care (NPA, 2006). In other works, the PACE provider gets one capitated rate and assumes risk for all acute and chronic care. Bill McGuire, CEO for United Health, Inc., recommends that we must deal with the increase in spending on healthcare for seniors from $700 billion annually going to $1.6 trillion by expanding support care. He says we must look at the expansion in complexity and chronicity of seniors due to the interventions earlier in their lives that prolong the lives of people we wouldn’t have to take care of otherwise if they had died earlier. McGuire says we “get better in the use of resources relating to chronic disease and end of life care.” — Dan Strittmatter, Programs for the All-Inclusive Care for the Elderly (PACE) as Another Solution to the Growing Cost of Care for Seniors: A Review of PACE and How It Could Work in Minnesota----------------------- |
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