Author: Dr. Konrad Wienands
Position: Chief Consultant; Global Healthcare and Medical Research
Article: The Healthcare Discussion
by Dr. Wienands (Chief Consultant Medicine)and Katie Silcox
SCG Healthcare: Confronting the Problematic Global Healthcare Scenario
It is a well-known fact that many health care systems, and particularly that of the United States, are on the edge of a breakdown. While many countries in Europe and Asia have similar governments and economies as the U.S., they are currently applying different methods of healthcare implementation for ensuring that all citizens have access to basic health care needs. That said, while the United States faces one of the greatest healthcare challenges, more and more, the entire growing global community will be forced to reevaluate methods for more efficient health care management.
The Problematic U.S. Example:
A recent report from Janecka (2009) shows that through the model of systems science, “U.S. health care is commonly referred to as a system that consumes an ever-increasing percentage of the gross domestic product and delivers seemingly diminishing value.” This comparative study on U.S. healthcare found that the system itself is incomplete, and that “immediate corrective steps could be taken....to prioritize and incentivize health over care; restore fiscal soundness by combining health and life insurance for the benefit of the insured and the payer; rebalance horizontal/providers and vertical/government hierarchies.” (Janecka 2009)
One must only look at the current Obama–Biden “Plan for a Healthy America” for an overview of some the greatest problems in modern healthcare:
Ever increasing costs – “Health care costs are skyrocketing.”
Lack of affordability for the patient – “Over half of all personal bankruptcies today are caused by medical bills.”
Missing accessibility – “Over 45 million Americans … lack health insurance”
High incidence of medical errors – “About 100,000 Americans die from medical errors in hospitals every year.”
Over-administration – “One-quarter of all medical spending goes to administrative and overhead costs…”
Insufficient adaptation of modern IT technology – “…reliance on antiquated paper-based record and information systems…”
Negligence of prevention medicine – “… less than 4 cents of every health dollar is spent on prevention and public health.”
These poignant statement on the current situation in healthcare management offers not only an insight into the multitude of problems and shortcomings we face, but also a view into the ever-increasing costs of care, the unnecessary suffering of individuals, and in many extreme-cases, the untimely death of those most adversely affected. And while the statements from “Plan for a Healthy America” emphasize many of the problems of healthcare in a developed country (one presumably well-equipped with high-tech medicine and insurance systems), the situation on a global scale is far worse. The grotesque lack of accessibility to healthcare in many third world countries is one of the biggest human tragedies of modern times. It is clear that the state of current worldwide healthcare is spinning out of control. It is also clear that there is a substantial need for reforms and restarts within this outdated model.
If we look over the decisions and processes in past models of healthcare, we must ask, “Have the last few years shown any observable, substantial changes for the better?” Despite the fact that health care reformation and restructuring are a major topic in nearly all worldwide government programs, and despite the fact that healthcare is a main target-goal for countless NGOs, and beyond the fact that huge economic efforts have been undertaken to improve the situation, betterments are few and far between. Simply stated, it would be overly-optimistic to say that there have been any observable healthcare changes, globally, that can live up to the efficiency, magnitude, and speed of implementation essential for overcoming the rapidly increasing challenges that the world will face.
This healthcare hardship is accentuated by a growing world population and the ever-bleaker backdrop of a global economic crisis. We must also consider the rising rates of aging populations in industrialized countries, higher incidence of chronic diseases (requiring continuous treatment), as well as new and, possibly, very promising scientific breakthroughs, particularly in the field of genetics and molecular biology. It is essential that these new findings be integrated in our present health care systems worldwide. Clearly, these improved, high-tech systems will come at a cost.
The following section will highlight the striking mismatch between efforts and results in past approaches to the healthcare problem.
The Problematic Model Continues: Lack of Information
SGC’s Chief Consultant in Global Healthcare and Medical Research, Dr. Konrad Wienands, speaks on the problematic nature of the current healthcare system.
The single largest problem in the interaction between healthcare providers and patients is the lack of information. When you try to obtain information concerning your patient´s medical history, you invariably face a great deal of problems. In more than 25 years of medical practice, I had spent countless hours of time trying to collect even the most basic information about my patients´ medical history. Very often, a thorough evaluation of the medical history, in addition to the current complaints, can give you a valuable preliminary diagnosis. It can also help you to streamline further examinations and technical diagnostic procedures.
Furthermore, the majority of patients have no complete medical records for helping you understand the important details of past diagnoses and treatments, including the effect of the efforts of other health care providers.
Mostly, the patient can only tell you : “I visited Dr. X or hospital Y, and that this or that diagnostic procedure was performed, and that the Dr. said that
a) everything was fine or
b) I should take the pills whose name I cannot remember, and that I took those pills for some time but they didn´t seem to help so I decided to stop the therapy...”
What is more, when attempting to collect the information by phone calls, faxes, etc. from your colleagues, this tedious work is very slow. In all actuality, it is quite probable that you will not obtain any information at all.
Time and time again I hear, “Dr X. is seeing patients, he will call you back”, or “I cannot send this information by fax, because your identity is not confirmed,” or “Our practice is closed, please call back later,” or “The record department of our hospital will send you the information soon.” The excuses are endless.
Furthermore, medical reports contain obsolete phrases such as:
“We take for granted that the detailed medical history is known to you and refer only to the recent problems.”
“Concerning the lab results you find that result X was pathologic with a value of Y, the rest of the results are within the normal limits.”
Seldom will you encounter copies of original results (i.e. imaging data, X-rays, etc.). For a medical doctor, oftentimes a look at the original pictures, rather than the written results, can be an invaluable tool in your personal decision-making processes regarding the state of health and procedures needed for the patient. Certainly, you will never find a timeline of any former therapeutic activities or the results of these activities. Many people are unaware that by knowing these details, you can make a much better personal assessment of the whole process in disease management and diagnosis. For the most part, records are presented as textual artifacts. This type of presentation of a patient record makes it very difficult to get an in-depth overview, and the textual data can be appallingly large. Oftentimes, I have found myself digging into reports, from varying sources and styles, the size of a medium paperback book. Often, especially in chronic disease cases, in order to come to a necessary conclusion, you must combine different sets of important data by painstakingly transcribing it into an appropriate representation via spreadsheets. This is also a tedious waste of time and effort, that could easily be avoided.
What is the result of this chaos?
On one hand, patients are in danger of being repeatedly treated with the same interventions that have proven to be ineffective in the past. What is worse, a patient may be treated with a procedure that has produced an adverse effect in the past. On the other hand, without proper information, what was perviously an effective treatment may not be used as a favorable therapeutic option in the present. The typical way to avoid mistreatments and medical errors in such a situation is to undertake a very extensive diagnostic process, where you hope you can gain enough information to proceed without sufficient medical history data from the patient in question.
The Current Financial Black Hole for Healthcare: Lack of Patient Information
I estimate that the expenses that could be saved by avoiding unnecessary and repeated diagnostic activities, in the context of modern high-tech medicine, to be at least 30%. Moreover, we must consider that the direct consequences on the patient are far worse than the economic expense on the system. Extensive diagnostics will frequently produce ambiguous results, leading to more diagnostics, robbing the patient of time, and delaying therapy. If the diagnostic procedures are invasive and have possible severe side-effects, you may be unwillingly damaging your patient´s health, or in the worst-case scenario, causing an unnecessary patient death due.
The lack of information problem necessitates the following essential properties of a better health care system:
Each and every patient needs a complete medical record, including original data from technical diagnostic procedures in digitalized form.
The health problems, diagnoses, and treatment information has to be stored in a centralized database.
This data must be instantly accessible.
The data should be presented in a form that facilitates extracting information easily and intuitively.
Graphical representation of patient data.
Privacy and data protection have to be perfectly embedded into this process.
An implementation of these needs, through the use of modern computer technologies, would eradicate thousands of medical errors, while at the same time saving an incredible amount of money spent in our health care systems today.
Janecka, Ivo P. Is U.S. health care an appropriate system? A strategic perspective from systems science. Health Research International. January 2, 2009.