18 September 2012

Who cares about patients?

Marty Makarty discusses the US health care system: 
A host of new studies examining the current state of health care indicates that approximately one in every five medications, tests, and procedures is likely unnecessary. What other industry misses the mark that often? Others put that number even higher. Harvey Fineberg, M.D., president of the Institute of Medicine and former dean of the Harvard School of Public Health, has said that between 30 percent and 40 percent of our entire health-care expenditure is paying for fraud and unnecessary treatment. Marty Makary, Are hospitals less safe than we think?, 'Newsweek', 17 September
We shouldn't really be surprised. The disconnect between the decision-makers and ordinary people is about as wide in medicine as it is in education, justice or politics the world over, which is to say: vast. This gap is filled by middlemen: lobbyists, government agencies with their own agenda, and other vested interests representing big corporations or purporting to represent labour. Outcomes that matter to ordinary people are a long way down the list of priorities for these organisations. Marty Makary's article later points out that there is information readily available that would see appalling doctors and surgeons struck off... but it's not made available to those who would benefit from it. Instead, hospitals, just like every institution, whether it be a government agency, corporation, trade union, or church, have as their over-arching goal that of self-perpetuation. The interests of the people they are supposed to serve are incidental. And the predictable result, in medicine as in other areas of social and environmental policy is tragedy and waste. Our impotence in the face of big government and powerful organisations leads to alienation and cynicism about the whole political process.

Social Policy Bonds could close the gap between policy and outcomes that actually benefit ordinary people. Instead of having to satisfy organisations with deceptive names that promise to get things done, a bond regime would reward only the successful achievement of meaningful outcomes; however they are achieved and whoever achieves them. In the world of medicine, enlightened governments (or philanthropists or non-governmental organisations) would issue and back bonds that are redeemable only when broad health outcomes  (perhaps expressed as an index of longevity, infant mortality, Quality Adjusted Life Years, etc) have been achieved and sustained.

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