September 9, 2006
Consumer-Driven Health Care
The terrific Ezra Klein has a new post on the problems with cosumer-driven health care, focusing particularly on the problem that most patients do not have the means or knowledge to evalutate accurately the health care they receive. He writes,
Over in the Wall Street Journal, more empirical scorn is being heaped on consumer-drected health care, this time in the form of a study showing that consumers have absolutely no idea what good health care is. Researchers from the Rand Corp., UCLA, and Department of Veteran's Affairs had 236 elderly patients in two major managed care plans rate the quality of their health care. Satisfaction was high, with the average rating a super 8.9.
Then the researchers sat down to rate the care these same patients received. They compared care received to care that should have been received, checking on fundamental metrics like whether a patient received aspiring within an hour of being diagnosed with acute myocardial infraction. Scores plummeted. Despite the high level of patient-satisfaction, the researchers gave the care a failing grade of 5.5. More interesting, the patients who rated their care as a 10 were just as likely to be getting low-quality care as those who reported a 5.
The problem? Patients are not qualified to evaluate good care. They're qualified to evaluate whether the doctor was nice to them, whether he explained things clearly, whether the wait time was short and the experience pleasant. They do not know how well their care matched up to accepted standards of care, and they do not know whether the treatments they were given were comprehensive, well-targeted, or adeptly conducted.
Oops! Read the rest of his entry and the comments - very illuminating.
September 7, 2006
Disability Convention: US Unlikely to Sign
An interesting article in the New Standard reports that United States has played a large role in influencing the new Convention on the Rights of People with Disabilities but doesn't want to sign on to it. The article states:
The United Nations has been working on the Convention on the Rights of Persons with Disabilities since December 2001, when it formed ad-hoc committees to study the issue. Five years later, UN delegates are in a final week of negotiations over provisions of the draft convention, which aims to promote respect, autonomy, non-discrimination, inclusion, accessibility and equal opportunity for people with disabilities.
"Our view is that the US actually already has in existence on the federal level, the state level and the local level a very good framework of laws and practices to assist citizens with disabilities," Paul Denig, with the US State Department, told The NewStandard, referring to the 1990 Americans with Disabilities Act (ADA). "In our view, this treaty would not add to that." . . .
Silvia Yee, staff attorney at the California-based Disability Rights Education and Defense Fund, said it is important for the US to sign the treaty to show support for the world’s 650 million people who have disabilities, many of whom currently have few rights. . . .
"Though the US refuses to sign the convention, it has been heavily involved in negotiations on many of the draft’s provisions, including end of life issues; parental decision-making regarding children; the prohibition against involuntary sterilization; and informed consent for genetic testing, medical research and scientific experimentation.
Yee said she does not believe US opposition to signing the convention has anything to do with the issue of disability rights.
"I think it’s because the US just doesn’t necessarily believe in the international treaty and rights monitoring model," she speculated. "I think it has always been very staunch about the sovereignty of the United States and not necessarily in favor of any giving up of that sovereignty in terms of recognizing international bodies."
According to the UN Secretariat Thomas Schindlmayr, only 45 countries have anti-discrimination legislation protecting disabled people. The General Assembly’s ad-hoc committee is scheduled to wrap up negotiations today.
Mark McClellan Resigns
Yesterday, the New York Times reported that Dr. Mark B. McClellan, announced that he will resign as administrator for the Centers for Medicare and Medicaid Services early next month. His announcement included a statement concerning how proud he was "to have provided prescription drug benefits to older Americans in the biggest expansion of the program since its creation 40 years ago." The Times article demonstrates how controversial some of his decisions were. According to the Times,
Democrats have made clear that if they win a majority in either house of Congress, they will investigate many of Dr. McClellan’s decisions. . . .
Senator Charles E. Grassley, the Iowa Republican who is chairman of the Finance Committee, said: “There were bound to be some start-up problems, and glitches continue. Dr. McClellan has worked to fix the problems. I hope that his departure doesn’t cause delays in getting snags fixed for beneficiaries and that he’ll correct all known problems before he leaves.’’
No one was named to succeed Dr. McClellan. His agency accounts for about one-fifth of the entire federal budget, spending more than $550 billion a year on health care for more than 90 million Americans.
The next administrator faces two huge political challenges. One is how to reverse increases in the number of people without health insurance and how to pay for Medicare and Medicaid, whose costs are expected to soar as millions of baby boomers age.