Patients as Consumers

March 1, 2018 By e-Patient Dave 2 Comments

We must democratize healthcare.

To achieve its potential, healthcare must be democratized.

I’ve reached this conclusion after hundreds of speaking events in eighteen countries over nine years. For me “speaking” has always involved a lot of listening and learning, and the more I’ve learned, the more I’ve puzzled over this paradox:

Medicine can save incredibly more lives today than ever (evidenced by the extraordinary growth in elder population in my birthday post “65!”)
Yet we still have terrible shortfalls: we have sewage leaks in operating rooms; we have medical errors causing hundreds of thousands of deaths in the US every year; and much more.

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November 14, 2017 By e-Patient Dave 6 Comments

American healthcare: a malignant tumor that can’t stop killing its host

As I said recently, I’ve been writing less here for a number of reasons. One is that I’ve been asked to write on other sites. Another, a sobering factor, as that after years of study, I’ve concluded that the American healthcare system has tied itself in a fatal knot. The post shown here, on the Patient Power blog, is an example of both.

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July 7, 2017 By e-Patient Dave 7 Comments

Hospital advertises “Private suites. Caring staff. Room for family.” Bring it on! :-)

“Private suites. Caring staff. Room for family.” Woohoo!

On the way home last night I drove past this billboard, turned around, and went back to snap this photo. See, hospitals know that if we have a good maternity experience we’re more likely to come back when sick, so they offer this.

Fine with me, but when we DO come back, shouldn’t we get what they promoted?? Let’s ASK them to provide it, for ALL healthcare! Otherwise it’d be kind of a bait & switch, now wouldn’t it. :)

Empowered patients & families praise ’em when they do well, and when they don’t, we ask for what we need. Do it!

Edit: In a comment below, @MightyCasey points to another factor I should have noticed: while hospital marketing departments are promoting the service provided in their maternity suites, the grim reality remains that the US has the worst maternal mortality rates in the developed world. Here’s the chart from one of the NPR posts Casey links to, which uses data from a big (38 page) article in Lancet last year. Look at US healthcare’s performance in the past generation – this is the number of dead mothers per 100,000 live births; :

In short, while the marketing is ramping up, actual delivery of maternal care is getting much worse, especially compared to what other developed nations are doing.

China, for instance (not shown in this graph) has improved since 2000 from 85.2 maternal deaths to 17.7, while we’ve gone from 17.5 to 26.4. This matches my recent post on the e-patient blog about “amenable mortality,” which is whether a system actually delivers the care that it knows how to do.

June 16, 2017 By e-Patient Dave 2 Comments

The effectiveness of the US health system, in one graph

I’ll leave you with this thought for the weekend.

After years of study of healthcare around the world, listening to an immense number of arguments about what’s important and what works and doesn’t, it’s all summed up in this one picture. The Y axis is life expectancy; the X axis is cost. This graph has been tweeted furiously and often lately by health journalist @DanMunro. (More on him below.)

You can easily see that US health costs per capita are way, way, way out of whack with the rest of the world. And, the life expectancy we get for it is years worse than the countries that cost 2-3x less.

Some will argue bitterly that the facts aren’t relevant, or a hundred other arguments. I’ve lost interest in those arguments, because they’re all about rationale, and no rationale is worth a damn if the outcomes they’re trying to explain don’t match the rationale.

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April 10, 2017 By e-Patient Dave Leave a Comment

Do you understand your healthcare costs? See what New Orleans is finding.

For years I’ve blogged about the difficulty of shopping responsibly for healthcare. Well, late last week some big news broke – big enough that I did an overnight makeover of my home page and added a new page to my site. This is the first chance I’ve had to blog about it.

The news is that the work of my longtime friend Jeanne Pinder at ClearHealthCosts is finally getting the widespread attention it deserves: in New Orleans, award-winning investigative reporters at both Fox 8 TV and the Times-Picayune newspaper have dug right in and started using the ClearHealthCosts software system both to report the insane price variations and, importantly, let the public submit more to flesh out how much is known.

Fox 8 reporter Lee Zurik fired the first salvo, a 7-1/2 minute long segment – which, as you know, is a huge length of time for an evening news piece. Then Times-Picayune investigative reporter Jed Lipinski posted his separate piece – see screen capture above.

Here’s my page on the series with links to both pieces and all my past posts: Cracking the Code.

More to come, and here’s hoping many cities follow. We, the suffering consumers, danged well deserved to know where our money is going, and we deserve to know what our options are, before the bill arises.

April 12, 2016 By e-Patient Dave 6 Comments

The difficulty of shopping when they hide the facts: that skin cancer RFP in the NY Times

$5,000-$7,000? $1200-$1500? $868? What should it cost to remove a simple skin cancer? What if you can’t find out?

Long-time readers know that in 2012 I was on high deductible insurance – and I don’t mean Obamacare-style $3,000 deductible, I mean $10,000 deductible. I chose that gladly, because I had laboriously analyzed the five plans available to me. I know insurance is a game of sharing risks, so I analyzed (it took all my Excel skills) and chose.

What happened next is described in a column in today’s NY Times by Tina Rosenberg, Shopping for Health Care: A Fledgling Craft: within months I discovered I had a skin cancer on my face. I became a highly motivated shopper, and quickly discovered nobody could tell me what would be on my bill.

The details are in several skin cancer posts here. But Tina Rosenberg writes about social problems, and I want to draw attention to the nature of this social problem: it withholds power from the person whose health is at stake, and that’s just plain wrong.

Here’s the World Bank’s definition of empowerment, from a January post:
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