Re: 6. Measurement

rwseed — Sat, 18 Apr 2009 16:00:14 -0000

I suppose the issue is in your second sentence, that is goals of the
study. Also why is the community size important? What I think is that
healthcare overall has not had any increase in productivity as
measured by cost per improved results in years, per physician. The
expense goes up, but not the improvement yield. Until doctors or the
future others who do the same work, are employees of service
industries, the conflict of interest in making money by the private
practice MD will interfere with effective changes. Their are models
of high quality care in total salaried systems that could be cost
effective. About 20 years ago I wrote the director of Blue Cross/Blue
Shield in Chicago and proposed doing elective inguinal repairs for 50%
of their total professional and facility costs....if they referred me
250 per year. They could measure my results by return to work, by
patient pain med use, by recurrence rate (which actually takes
sometime to know), and any other parameters they wanted. No response.
They did not dare use an efficient system and direct patients away
from others. I did all my inguinal hernias under local as
outpatients from 1975 until I retired in 2000. Not one was ever
hospitalized. The cost was quite low. The patients were happy and so
was I. The main point is that without the power to direct care to the
most efficient and competent delivery systems the other forces will
lobby to protect their incomes and control. The AMA comes to

Re: 6. Measurement

rwseed — Thu, 16 Apr 2009 16:22:44 -0000

For many of the procedure based healthcare issues 10,000 people is too small. At most 5 generalist are needed, one general surgeon who will not be very busy, a pediatrician, ob gyn and no hospital at all. Thus it has to be closely integrated with a larger population base that supports the specialties and the equipment and the facility (i.e. hospital). The actual preventive healthcare is use of non-MD personnel. In fact if everyone living in the area is informed periodically that they are part of this study, that by itself will improve outcomes. That was proven years ago by the reduction of total mortality and morbidity between two surgical services in a VA hospital. One service was told every two weeks that they were being followed as a special study. They did not know that the study was simply what effect that had on their behavior. It was year long. The effect was significant, though the actual day to day behavior of the staff was not evident. Randolph W Seed MD PhD

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Re: 6. Measurement

Re: 6. Measurement