Why is our health care system twice as expensive as other countries with poorer outcomes?
Updated: 12/3/13 Hospital Costs: Do They Make Any Sense?
Updated: 12/3/13 "Observation Services" is ER's America Cost Billions?
Updated: 11/26/13 Obamacare allows single-payer?
Updated: 11/25/13 New Method to diagnose Sepsis--Could save thousands of lives.
Updated: 11/22/13 Do the Poor Die of Treatable Diseases?
Updated: 11/20/13 Is Health Care Spending Down Sharply Since Obamacare?
Updated: 11/18/13 Signs of a heart attack early. What are they?
Updated: 11/18/13 Obesity and Antibiotic use. A state by state study
Updated: 11/17/13 The Crisis of Antibiotics.
Updated: 11/17/13 Obamacare: How Will It Affect Supplemental Plans and Medicare Advantage Plans?
Updated: 11/16/13 Obamacare: How good is the President's promise that everyone can keep their current plans if they want to?
Updated: 11/13/13 Prescription Related Drug Deaths and Injury at all time high.
Updated: 11/13/13 Health Care Costs Poised to Take Over the American Economy: New Studies
Updated: 11/12/13 New Study: Health Care Costs Up: Outcomes Down
Updated: 11/12/13 US Official Medicare Website on Medicare and ObamaCare Changes
Updated: 11/11/13 Nationwide Update
Updated: 11/10/13 Obamacare and Medicare--December 7th Deadline.
Updated: 11/7/13 The NPR Take On ObamaCare-Cancellations and Subsidies
Updated: 11/6/13 New Ways To Look At Cancer
Updated: 11/6/13 Obamacare and the Cancellations: What Are The Facts?
Updated: 11/4/13 What Social Security Does Not Tell Widowers and Divorcees
Updated: 11/3/13 How Often Do Physicians Disclose the Errors of Other Physicians?
Updated: 10/29/13 Ok, What Are The Facts on ObamaCare-For the 15th time.
Updated: 10/28/13 Is Obamacare causing consumers to lose their policies?
Updated: 10/27/13 The End of Antibiotics?
Updated: 10/24/13 What is going on with the Health Care.Gov web site. Hearings.
Updated: 10/21/13 Are There Regional Differences in the kind of care you get?
Updated: 10/17/13 Older persons attitudes toward work and retirement-new study
Updated: 10/27/13 The End of Antibiotics?
Updated: 10/15/13 Hospital CEO pay unrelated to hospital quality and outcomes
Updated: 10/7/13 Dozens of Mental Disorders Don't Exist At All?
Updated: 10/7/13 Latest study on the costs of ObamaCare.
Updated: 10/07/13 What is driving up hospital costs. New study.
Updated: 10/7/13 Hospital Precautions Do Nothing to Stop Infections?
Updated: 10/6/13 Physician Use of Drugs. Is Something to Worry About?
Updated: 10/5/13 ObamaCare Depends up Millennials Enrollment
Updated: 10/4/13 The Epidemic in Hospital ICU's
Updated: 9/30/13 Five reasons Americans already love ObamaCare-Fox News?
Updated: 9/30/13 ObamaCare State By State Costs before Subsidies in a Graph
Updated: 9/30/13 The Battle of the ObamaCare Exchanges
Updated: 9/28/13 ObamaCare resisted in many Republican States, creating disparities.
Updated: 9/29/13 20 things to know about Obama-Care
Updated: 9/28/13 Senate Health Committee holds hearing on Hospital generated infections and Sepsis-2 hour video
Updated: 9/27/13 Is Congress Exempt from ObamaCare?
Updated: 9/27/13 ObamaCare Website up and running in time for Oct 1, 2013 enrollment date! Good deal. You can see what it will cost you! ObamaCare and Medicare--you can see how it will impact you as well.
Updated: 9/26/13 How ObamaCare will affect Medicare?
Updated: 9/26/13 Clinch your jaws, here comes the government shutdown and debt ceiling battles.
Updated: 9/26/13 The latest report on the costs of Obamacare. The savings are dramatic for most people apparently.
Updated: 9/25/13 Best Websites on Medicare I have found-for you or your parents.
Updated: 9/23/13 Obamacare Oct 1, deadline. What will happen? What you need to know.
Updated: 9/22/13 The Quality of Surgical Care and After Care May be Key to Health and Re-admission rates of Patients
Updated: 9/22/13 Unsafe Medical Care harms 43 million people a year?
Updated: 9/22/13 Antibiotic resistant bacteria: The Danish Example
Updated: 9/19/13 Antibiotic resistant bugs kill 23k a year in the US: CDC-A flurry of reports.
Updated: 9/18/13 Are Anti-biotic resistant deaths down?
Updated: 9/17/13 23 thousand deaths a year in US from infections?
Updated: 9/15/13 New Research on Understanding "What is Health"
Updated: 9/12/13 Do ICU units help patients or not?
Updated: 9/7/13 What is the detail of why American Health Care is so expensive? New Study
Updated: 9/5/13 Kaiser Study finds insurance premiums lower than expected under Obamacare
Updated: 9/5/13 Psychiatry and Drugs. What up with that?
Updated: 9/4/13 The Oct 1st deadline on Obama Care. Are you effected?
Updated: 9/3/13 More data on the costs of Obamacare and who is impacted?
Updated: 8/21/13 How to get fit at any age.
Updated: 8/20/13 Latest Data on the costs of Obamacare.
Updated: 8/18/13 The Deadly Truth About Sepsis
Updated: 8/3/13 Health Care Expenses Who is getting the trillions of dollars spent?
Updated: 8/2/13 Obama Care What are the facts?
Updated: 7/31/13 Consumer Report ratings on Hospitals
Updated: 7/26/13 35 things you need to know about 911, ER treatments, and ambulances.
Updated: 7/23/13 Income, Insurance Status and Race in Health Care Outcomes
Updated: 7/21/13 How many errors and misdiagnosis happen in American Health Care?
Updated: 7/14/13 How superbug antibiotic resistance bugs spread from Acute Hospitals to Community ones.
Updated: 7/11/13 Latest Study on American Health Care Outcomes
Updated: 7/8/13 Women, Prescription Drugs and Hospitalizations
Updated: 7/5/13 Doctors discover why and how antibiotics can harm patients.
Updated: 7/4/13 3/2 million infections in European Hospitals each year? God.
Updated: 6/28/13 Hospitals to be fined under Obamacare for re-admissions.
Updated: 6/24/13 New tools to fight infections in hospitals?
Updated: 6/22/13 The Five Most Common Regrets the Dying have.
Updated: 6/18/13 Super antibiotics in meat linked to hospital superbug infections
Updated: 6/17/13 Antibiotics and deaths from infections.
Updated: 6/17/13 Why are hospital costs some much higher than doctors for the same procedures? And how many medical records have errors?
Updated: 6/13/13 Population and the Health Care System
Updated: 6/8/13 Anti biotic infested meat no longer to be served in some hospitals. You didn't know?
Updated: 6/4/13 "50 mind-bogging facts about the American Health Care System?"
Updated: 6/4/13 What are new developments which might help in treatments to problems identified above?
Updated: The Bloomberg View of what should be done about the high health care costs.
Updated: 6/2/13 What the most expensive procedures in American Health Care?
Updated: 6/1/13 Will Obamacare cause employers to drop health insurance coverage?
Updated: 5/28/13 Medical Liability, Doctors, Hospitals, Patients and Medical Outcomes
Updated: 5/27/13 Patient Participation in Health Care Decison-Making?
Updated: 5/26/13 Ten point check list on what to do and look for once admission has occurred.
Updated: 5/25/13 Infection rates and death in hospitals
This blog will explore in the coming days several aspects of the American Health system.
I'll look at cost, mortality rates, infection control, the hospital incentive structure and other items seeking an answer to the question to why our health care system costs twice as much as those of other countries and we have poor and mediocre outcomes compared to those other countries.
But first we look at the most deadly of all situations for a patient entering a hospital for any reason: the threat of getting infections while there.
This is crucial and hospitals have not solved this problem. Death caused by compliations of surgery, or some other items most often is code for infection and means a patient, even a healthy one, got an infection after being admitted to the hospital. Doctors and hospitals will say pneumonia, sepsis and other seemingly unrelated items or blame it on the age or other unrelated diseases. But shock is a major reaction to serious infections: this leads on to these "complications."
(By the way many surgeons have to redo operations because a sponge was left inside the patient. Sponge counts are critical before closing the patients.)
We will identify the problem of infection first and then talk about what to do if you or loved one has to go to a hospital-The Wise Patient's Guide to Surviving a Hospital Stay."
"MRSA kills an estimated 20,000 people in the United States each year. The superbug, which is resistant to most common antibiotics, can attack wounds and trigger potentially lethal blood stream infections. Community-associated strains, while generally less virulent and susceptible to more antibiotics, can still cause significant morbidity and mortality.
"MRSA has generally been a significant problem only in hospitals," said Eili Klein, the report's lead author and researcher at Resources for the Future. "But the findings from this study suggest that there is a significant reservoir in the community as well." This community reservoir leads to a dangerous spread of community-associated strains from outpatient units into hospitals, according to Klein.
To curtail this spread, hospitals will need to step up infection control procedures, including those practiced in outpatient units."
Medline offers some suggestion on infection control
"99,000 people die due to health care-associated infections (HAI) every year in the United States and nearly 28 to 33 billion dollars are spent on these infections. Nationwide efforts through many organizations are now working to address this issue.
Put patients at risk
Increase days of hospitalization
Add healthcare costs
Are associated with morbidity/mortality being higher in acute care hospital settings
Are largely preventable (via better hygiene, scientifically tested techniques)"
Now we are ready to summarize to this point:
1. Infection is important because certain kinds of infections require fluids and/or antibiotics in a matter of hours and others can enter the blood stream and in 24 hours bring on fatal results. So speed is important.
2. Always get the name of the attending doctor and nurse so that you can call and keep up to date from the admission/treatment point from inception.
3. Always ask about what is being used to treat you or a loved one, and what are the alternative, less instrusive options. Never agree to emergency surgery unless you have throughly explored the options.
4. Get clear from the beginning on who is making decisions in the family on treatment and at decision points
5. Read up on what complaints or aliments you are dealing with on the internet-before not after treatment.
6. Look up the doctor treating your loved one and the hospital and the department--what has been their infection rates, mortality rates, accreditation issues and the like.
7. Check is to what are the details of any DNR(Do Not Resuscitate) you or your loved one might have.
8. If coma is involved ask before hand if doctors in their treatment plan will induce a comma or not.
70 percent of patients leave it up to the doctor on health care decisions?
But note doctors and medical law legally assume patients participate and make the decisions-even though we and they know patients don't. Doctors, therefore, have little responsibitity if things go wrong. (Same thing is now true in the accounting profession. Audits now mean nothing.)
So we ask, who exactly is responsible if something goes wrong with treatments from the doctor and the hospital? It varies state by state but let's look at the over-all picture.
First doctors and hospitals have limited their liabilities under various laws such that the burden of proof falls upon the patient, under the guise of "patient rights."
What this actually means is that under most state laws patients are legally responsible for making their own health care decisions, or the family. The doctor is only an "advisor." Couple that with limits on the dollar amounts patients can sue for and and limits on class action suits and doctors and hospitals have little liability for patients that die in their care.
15-20 percent of all patients in this country are harmed by the care they received.
If you realize that this occurs with the 2.2 million disease-related deaths a year the number is more than huge.
Couple this with the fact that unecessay testing is done by doctors and hospitals 90 percent of the time on patients resulting in higher hospital and doctor bills as well.
Doctors and hospitals justify all this testing claiming they are protecting themselves from lawsuits, but the fact of the matter is that their incomes are based on tests and procedures they perform and you get at the real reason for the testing-increasing their income.
Moreover, all this testing has been shown to be of little benefit to patients and the picture and incentive structure is clear: more tests, more money for doctors and hospitals. Add infection related income and the picture in not a pretty one.
The argument that such testing reduces doctors and hospitals liability and protects against lawsuits has been shown to be unrelated to both lawsuits and patient outcoms.
What is wrong with this picture?
Let's start with this article:
"However, AHRQ researchers reviewing the impact of these approaches found "little solid evidence" about the impact of medical liability reforms on the cost of care and even less information about the impact of these reforms on patient safety (Hellinger et al., 2009). Furthermore, the medical liability system may actually hamper progress on patient safety by dissuading physicians from disclosing and examining the root causes of medical errors (Studdert et al., 2004)."
What are other procedures driving up American health care costs?
"The high price paid for colonoscopies mostly results not from top-notch patient care, according to interviews with health care experts and economists, but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees."
Today we look at new developments in health care which may, repeat, may, help with some of the issues identified above.
What are the most promising developments related to infections and virual diseases?
"We found that the KKL-35 molecule inhibits the growth of very distantly related bacteria, and this suggests that it may have antibiotic activity against a very broad spectrum of species."
As for the Shigella and Bacillus anthracis bacteria, Keiler said his team was able to show that, "in the presence of the KKL-35 molecule, these cells died specifically because the molecule halted the trans-translation process." Keiler's team also found that, compared with currently used tuberculosis drug therapies, the KKL-35 molecule was 100-times more effective at inhibiting the growth of the strain of bacteria that causes tuberculosis (Mycobacterium tuberculosis)."
The costs of an aging population rise while the number of working people decline is a formula in both the US and Europe for decline. Populations which do not replicate themselves disappear replaced by immigrants. Similarly, China as the problem stemming from its birth control policy of one child per couple. Russia, Italy and Japan also must be included in this group.
"Perhaps mirroring its declining population growth, European countries tend to have older populations overall. European countries had nine of the top ten highest median ages in national populations in 2005. Only Japan had an older population."
"David Willetts, the science minister, said the over-use of antibiotics could be a "big global problem" on the scale of climate change and food security, as bacteria may increasingly grow resistant to the drugs.
Doctors have long been urged to rein in their prescriptions of antibiotics for coughs and colds. However, there are now growing calls for their use to be restricted in agriculture, as superbugs could eventually pass to humans who work on farms or through the food chain."
3.2 Million Europeans catch infections every year in hospitals? That is an astounding number
"A survey by the European Centre for Diseases Prevention and Control (ECDC) found that on any given day, one in 18 patients in European hospitals has at least one hospital-acquired infection - amounting to around 3.2 million patients per year."
"Worldwide, MRSA infects an estimated 53 million people annually and costs more than $20 billion a year to treat. It kills around 20,000 people a year in the United States and a similar number in Europe."
"Doctors often prescribe antibiotics freely, thinking that they harm bacteria while leaving human tissue unscathed. But over the years reports have piled up about the occasional side effects of various antibiotics, including tendonitis, inner-ear problems and hearing loss, diarrhea, impaired kidney function, and other problems."
This article has an oblique point of view but good information is there and the focus is on hydrocodone.
Americans living longer but with more health care problems.
“Despite a level of health expenditures that would have seemed unthinkable a generation ago, the health of the US population has improved only gradually and has fallen behind the pace of progress in many other wealthy nations. In fact, by every measure including death rates, life expectancy, and diminished function and quality of life as assessed by the authors, the US standing compared with 34 Organisation for Economic Co-operation and Development countries declined between 1990 and 2010.”
Obama Care: What are the facts:
#Last, but certainly not least - premium changes are unlikely to affect you at all. The rates submitted to states and the federal government are for coverage sold to individuals and small businesses with fewer than 50 workers that are not self-insured. Currently, the vast majority of Americans with insurance coverage get it through their jobs – and they generally work for companies with more than 50 workers. Large firms already offer coverage similar to what the health law will require insurers to offer individuals and small firms, so little change is expected. The new rates are most likely to affect people who buy their own coverage. About 15 million do so currently and an estimated 7 million more are expected to do so next year because of the health law.#
The deadly truth is that this can kill you even when you are already in a hospital, but they miss the diagnosis and you get an infection from the hospital itself. See above in this blog for more information about Sepsis which I consider to be one of the most deadly of all diseases, because it can kill you in 48 hours. So speed of treatment is essential, especially if you are in a foreign country.
"Sepsis is a life-threatening condition that arises when the body's response to infection causes system-wide inflammation, injuring tissues and organs. It's sometimes called blood poisoning, and a number of cases occur as a result of seemingly benign incidents — like a scrape on the playground or even a large paper cut.
In other cases, like Kerri's, sepsis can start out as a garden-variety infection but quickly turn into something more serious. Frighteningly, the number of people hospitalized for sepsis has more than doubled in the past decade, partly due to increasing antibiotic resistance as well as an aging population.
"Every week I have to tell three or four families that their loved ones are dying from something most of them have never heard of," says intensive care physician Jim O'Brien, M.D., of Riverside Methodist Hospital in Columbus, Ohio. Sepsis strikes seemingly at random, and sometimes is missed even by seasoned physicians. "We don't have a diagnostic test for sepsis. And doctors have not organized our care around sepsis like we have around "
New Research on Understanding "What is Health?"
"We often think of human cells as tiny computers that perform assigned tasks, where disease is a result of a malfunction. But in the current issue of Science, researchers at The Mount Sinai Medical Center offer a radical view of health -- seeing it more as a cooperative state among cells, while they see disease as result of cells at war that fight with each other for domination."
Antibiotic resistant bacteria: The Danish Example
"In 2012, 1,556 Danes were found positive with methicillin-resistant staphylococci -- MRSA. This represents an increase of 20% from 2011. In fact, the total number of cases has almost doubled since 2009. MRSA bacteria are resistant to antimicrobial agents that are essential for treatment of treating life-threatening infections in humans."
Unsafe Medical Care harms 43 million people a year?
'More than 43 million people are injured worldwide each year due to unsafe medical care, according to a new study from Harvard School of Public Health (HSPH). These injuries result in the loss of nearly 23 million years of "healthy" life."
The Quality of Surgical Care and After Care May be Key to Health and Re-admission rates of Patients
"The results showed that approximately one in seven patients discharged was readmitted within 30 days. Hospitals with the best performance on two well-established measures of hospital surgical quality, surgical volume and 30-day mortality rates, had much lower readmission rates than other hospitals. For example, hospitals in the highest quartile for surgical volume had a significantly lower readmission rate than hospitals in the lowest quartile (12.7% vs. 16.8%). Hospitals with the lowest surgical mortality rates had a significantly lower readmission rate than hospitals with the highest mortality rates (13.3% vs. 14.2%)."
" In these 36 states, a single 27-year-old would pay an average of $214 a month for the lowest-cost silver plan before the tax credit. After the credit is applied, it would cost $145 a month, which is an additional 33 percent discount. The federal government would pay the difference of $69 a month directly to the insurer, which, is a boon for their business but also saves that 27-year-old $828 a year in out-of-pocket expenses."
"Just 27 percent of people ages 19 to 29 had heard of the health insurance exchange marketplaces, where people who don't get coverage at work will be able to shop for insurance plans and learn whether they qualify for subsidized benefits, the Commonwealth Fund poll of almost 1,900 people between November 2011 and March 2013 reveals. Awareness was even lower among people who were uninsured during part of the prior year and whose incomes will make them eligible for help, at 19 percent and 18 percent, respectively."
"In the late 1980s, both the Lancet and the New England Journal of Medicine published the findings that Boston residents were hospitalized 60% more often than their counterparts in New Haven. Oh, by the way, the rate of death — and the age of death — in the two cities were the same."
Health Care.Gov website. What is going on. Hearings
Is Obamacare causing consumers to lose their policies?
" By all accounts, the new policies will offer consumers better coverage, in some cases, for comparable cost -- especially after the inclusion of federal subsidies for those who qualify. The law requires policies sold in the individual market to cover 10 "essential" benefits, such as prescription drugs, mental health treatment and maternity care. In addition, insurers cannot reject people with medical problems or charge them higher prices. The policies must also cap consumers' annual expenses at levels lower than many plans sold before the new rules."
"New estimates released from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) project that aggregate health care spending in the United States will grow at an average annual rate of 5.8 percent for 2012-22, or 1.0 percentage point faster than the expected growth in the gross domestic product (GDP)"