Wednesday, January 28, 2009

Healthcare That Puts a Computer on the Team

The New York Times is increasingly a reputable source for medical information that is timely but also relevant to the discussion about healthcare reform and asking ourselves as a society a simple question - are we getting value for our healthcare dollars?

The series - the evidence gap - is an excellent forum to review. Its article about how information technology / computers is improving the delivery of care is important to understand what the American healthcare could look like if all doctors and patients were hooked up as easily as we do now with email, web surfing, and blogging.

As someone who works at one of these organizations, I will never go back to paper-based records. The computer helps me review data quickly, share them with patients online, in the office, or over the telephone, and permits me to spend more face to face time.

Frankly, I despise reviewing paper charts, particularly for new patients joining my practice, not simply because of the amount of paper shuffling I need to do to find important clinical data to keep them healthy, but because a lot of their doctors have illegible handwriting, which alone jeopordizes patient safety.

Sunday, January 18, 2009

Book Review - Critical: What We Can Do About the Health-Care Crisis

I had high hopes for this book. Except for the one innovative idea, the creation of a Federal Health Board, this was an average book compared to the many available which detail the challenges of our dysfunctional healthcare system far better. The book is an easy read, doesn't cover much in depth, but highlights all of the key points one needs to know to speak intelligently about the healthcare system (and presumably to be Secretary of Health and Human Services).

It is unclear whether creation of a Federal Health Board will be able to provide the impetus needed to make the American healthcare system higher quality, less costly, and more inclusive with universal coverage. One thing is clear from his book and that is Americans want a better healthcare system than currently exists. It won't be a pure single payer government run system. It won't be a free market private industry program. It will be a hybrid. What type of hybrid? Time will tell.

The book is divided into five parts. Part One details the healthcare system in crisis filled with individual anecdotes on how it has bankrupted, failed, and at times killed people without adequate insurance coverage or financial means to pay for care.

Part Two talks about the history of healthcare reform, which covers the beginning of the twentieth century. It highlights efforts by President Truman, Medicare and Medicaid legislation, as well as attempts in the 1970s, 1980s, and the early 1990s.

In Part Three, Daschle looks at why reform hasn't occurred. He begins to build his case for creating a new entity, a Federal Health Board, which is modeled after the Federal Reserve as well as the British National Institute for Health and Clinical Excellence (NICE).

Part Four he focuses in on how the Federal Health Board would be structured (a central board with several regional boards). As an independent body, it would recommend that only medications, treatments, and procedures backed by medical evidence and not by marketing be covered under government run insurance plans. It would also determine what criteria and benefits private insurers must offer to participate in expansion of the FEHBP (Federal Employees Health Benefits Plan). This new market would insure those unable to get employer-based or government run insurance programs currently.

Finally in Part Five, he makes the case on the likelihood for healthcare reform.

The best part of the book is Senator Daschle's perspective on the healthcare reform attempt by the Clinton administration, particularly how excitement and momentum moved the country towards reform only to see external events, special interest groups, as well as political missteps, caused it to die. Without a doubt, future leaders who hope to forward any healthcare reform package would best learn what not what to do.

Read my other healthcare / medical book reviews -
Overtreated -
How Doctors Think -
Medical Myths That Can Kill You
How To Save On Prescription Drugs

Sunday, January 11, 2009

Favorite Websites of Doctors

I'm increasingly learning more about healthcare through important physician writers like Atul Gawande, Bob Wachter, as well as Pauline Chen. In Dr. Chen's most recent NY Times article, she highlights favorite website of doctors. It's an excellent list that all patients should reference.

In a time when patients can access quickly a vast amount of information using the internet (especially Google), it is vitally important that they have a list of trustworthy resources which are worth the time, particularly since some information on the internet is frankly wrong and preys on people's false hopes.

The experts quoted in the article note that there are real differences among healthcare providers (doctors, hospitals, insurers) in providing great care beyond the bedside manner. In other words, healthcare providers like other goods and services we purchase are not all the same with some far better than others.

With the economic and financial crisis we are all facing, it is important that as we select doctors, insurers, and hospitals that we research which ones provide us the best value and service in keeping us healthy and well.

I would only add another excellent website, particularly when researching the best health insurance plan is at, the National Committee for Quality Assurance. NCQA is a not-for-profit organization that rates health insurance plans on how well they keep people healthy and those who have problems like diabetes, asthma, heart disease that they get the most up-to-date care.

It also has under the Report Cards section the Physician Recognition Program. These are doctors who have voluntarily submitted their patient charts to NCQA on various conditions like diabetes, heart disease, to name and few, and have shown that they consistently provide the level of care recommended by expert committees of the American Heart Association and the American Diabetes Association. Research consistently shows that we only get the recommended preventive care only about half the time in this country. If you are spending a lot for healthcare, shouldn't you get the doctors who consistently provide the highest quality of care?

Tuesday, January 6, 2009

Save money on medical care, prescription drugs, and more

A new year means a new opportunity to do better. This year, in particular with a new president, there has been a lot of talk about healthcare reform. Even under the most optimistic situation , if legislation passed tomorrow , significant changes would still be years away. What can you do to make sure you are around and not bankrupt to see these reforms occur? Healthcare and medical expenses are the leading cause of personal bankruptcy. Do the following:
  • Get preventive screening tests done. Even if you feel well, find out what tests you should get done even if you feel well. You do get routine maintence for your car don't you? Why? So it doesn't break down. Well how about your body?
  • Pick a primary care doctor to be your healthcare advocate. Either an internist or family doctor will do. Research consistently shows patients who have a primary care doctor coordinate care and who is the first logical step to access the healthcare system not only are healthier but also spend less to get there.
  • If you need medications, always insist on generic medications. They aren't inferior. They are medications that previously were branded but no longer have patent protection. This means other pharmaceutical companies can manufacture the medications resulting in decrease prices. Recent generic medications over the past few years include allergy medications CLARITIN, ZYRTEC, cholesterol lowering medication ZOCOR, and heartburn medication - "the purple pill" PRILOSEC. Notice how before they went generic, companies plastered the airwaves and print with advertising. Now that they are generic, no one seems as enthusiastic, yet the medications work just as well for a lot less.
  • Consider getting medications at Wal-mart or Target. At $4 copays for many generic medications and $10 copays for a 3 month supply, these are often cheaper than the plans offered by insurance companies.
  • Eat less. With the economic crisis, people are more careful with their money. With 2/3 Americans already overweight or obese, changing your diet by eating less not only might save money, but also help you get healthier. Fewer calories in means less likely to add weight. It takes 3500 calories to equal 1 pound.
  • Invest in walking shoes or other cheap forms of exercise. Forget the gym, unless you already do it regularly. Go for a regular walk. Realize that a 30 minute walk only burns about 200 calories, which means to lose weight, not only do you need to move more but also eat less.
  • Quit smoking. Drink in moderation (if you want to).

With all of these tips, not only will you improve your physical health, you might also help for financial health. By being healthier, you might be around long enough to see true healthcare reform and not be bankrupt in the process.


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