Is Medical Care Obsolete?

Article excerpt

Last fall, a group of us from the Institute of Medicine of the National Academy of Sciences published the results of an intensive multiyear study of health care quality in the United States. we concluded that:

"Serious and widespread quality problems exist throughout American medicine. These problems, which may be classified as underuse, overuse, or misuse, occur in small and large communities alike, in all parts of the country, and with approximately equal frequency in managed care and fee-for-service systems of care. Very large numbers of Americans are harmed as a direct result. Quality of care is the problem, not managed care."

The terms underuse, overuse, or misuse are best defined by simple examples with which you're all familiar: Underuse is failing to give an antibiotic for a bacterial infection. Overuse is giving an antibiotic for a viral infection, for which it does no good. Misuse is giving the wrong antibiotic or the wrong dose, or giving it the wrong way.

Unfortunately, the debate in Congress has ignored these findings. The discussion in Washington has been about the rights of Americans covered by health plans and whether they can sue them. Kaiser Permanente has long supported enforceable national standards that provide necessary protection to consumers. We first articulated these well before Congress took up the current legislation in the form of our "Consumer Protection Principles" which we promoted along with Families USA, American Association of Retired Persons, and other like-minded health plans.

Nonetheless, Congress is not addressing what I consider two more critical issues in health care: First, the 43 million Americans who have no health insurance at all, and second, whether the health care that insured Americans do get is safe and effective. The issue of the uninsured would require more time than we have today. Instead, I'd like to focus on the ultimate patient protection--patient safety.

Patient safety is not a new problem. In their landmark medical practice studies conducted nearly a decade ago, Lucien Leape and his colleagues examined the frequency of medical care accidents in the hospitals of New York State and in Boston's leading teaching hospitals. These investigators have documented that mistakes in diagnosis, failure to apply critical preventive precautions, errors in medication use, failures of equipment and technologies, and unforeseen complications of treatment occur with far greater frequency than anyone originally thought.

If the data in these studies is extrapolated to health care in general, one could conclude that accidents resulting from the misuse of medical technologies are responsible for an estimated 400,000 deaths yearly. These accidents are not listed among the leading causes of death in the U.S. However, if they were, these studies suggest that they would rank third--more than tobacco, stroke, diet, alcohol, drugs, firearms, or automobiles, and behind only heart disease and cancer.

Two thirds of health care accidents are preventable; the other third occur as a result of unexpected complications of treatments (like a life-threatening allergic reaction to penicillin) that can be as dangerous as the benefits we would like them to conifer. These numbers do not include the impact of care underuse or overuse. Were fatalities from these quality problems added to those from accidents, the number of deaths would climb significantly.

We have a problem.

Because of the urgency of the problem of safety in health care, a group of us began meeting over two years ago under the aegis of the Kennedy School at Harvard. Our purpose is to understand the causes of the problem and to develop and implement solutions that improve safety in health care.

We found it helpful to start with the experience of the airline industry, which cut commercial aviation fatalities by 80% from 1950 to 1990. Improvements of this magnitude have continued in the 1990s in the face of a dramatic increase in the volume of commercial air traffic. …