Before I arrived here, I assumed that the UK had a major advantage when it came to improving patient safety and quality. After all, a single-payer system means less chaos and fragmentation—one payer, one regulator; no muss, no fuss. Simple problems are ones in which the inputs and outputs are known; they can be managed by following a recipe or a set of rules. Baking a cake is a simple problem; so is choosing the right antibiotics to treat pneumonia.
The claim that health insurance improves health outcomes is hardly ground breaking.
Studying whether insurance affects health status is like wondering whether three meals a day lead to a higher muscle mass than total starvation. Baicker et al found that Medicaid enrollees fared no better in terms of health outcomes than those without insurance.
That is, no insurance no difference. The study is an exemplar of policy research laced with regression equations, control of known confounders and clear separation of variables. There is only so much rigor social science can achieve compared to the physical sciences. Yet this is about as good a study as is possible.
The one thing the study did not lack was sample size. Large effects do not need a large sample size to show statistical significance. Conversely, if study with a large sample size does not show even a modest effect, it means that the effect probably does not exist. So where is the downside?
Could the downside of a government program paying physicians, on average 52 cents, and as low as 29 cents, for every dollar paid by private insurance in a multiple payer system be access? But one I least expected was that patients on Medicaid do worse than patients with no insurance risk-adjusted, almost.
I am not going to be that remorseless logician, which John Maynard Keynes warned us about, who starting with one mistake can end up in Bedlam, and argue that if you are for Medicaid that is morally equivalent to sanctioning mass murder.
Rather, I ask how it is possible that possessing Medicaid makes you worse off than no insurance whatsoever. To some extent this may artifactually appear so because poverty correlates with ill health, and studies that show Medicaid patients faring worse than uninsured, cannot totally control for social determinants of health.
However, I found a plausible explanation during a recent conversation with a physician specializing in physical medicine and rehabilitation PMR.
She ran a special clinic one day a week in which she saw adolescents for free. These kids had no insurance.
They were mainly from the local Hispanic and African American communities. She did not accept Medicaid patients.
This point is worth parsing out again. This doctor is happy to see patients uncompensated but not Medicaid patients, partially compensated. Why so, I asked, bewildered and feeling that I must be in Bedlam.AbstractionOver a decennary ago the Institute of Medicine (IOM) issued two startling studies.
To Err is Human: Building a Safer Health System and Traversing the Quality Chasm both of which highlighted insufficiencies in the American health care patterns.
|Alternative Names||Collapse of Industrial Civilization Civilizations are living organisms striving to survive and develop through predictable stages of birth, growth, maturation, decline and death.|
|Quality Care Managment Model Essay Sample||There is one essay for the Academic test and one for the General Training test. You can all benefit from both of them.|
|The Great Abbreviations Hunt||Spain occupies about 85 percent of the Iberian peninsula, with Portugal on its western border. Other entities in Iberia are the Principality of Andorra in the Pyrenees and Gibraltar, which is under British sovereignty and is located on the south coast.|
|Thank you for considering my candidacy!||I've consistently performed as the "key" player in guiding senior management on how to identify and convert inefficiencies and inequities in line operations into efficient or new revenue streams.|
Those studies compelled healthcare professionals to measure the quality of the work . - Hospice Care Nurse Definitions of palliative care, hospice care, DNR orders, and end-of-life care Hospice care is a model of care that focuses on relieving symptoms and supporting patients with a life expectancy of six months or less (Altshuler, ).
Identification. The name España is of uncertain origin; from it derived the Hispania of the roman Empire. Important regions within the modern nation are the Basque Country (País Vasco), the Catalan-Valencian-Balearic area, and Galicia—each of which has its own language and a strong regional identity.
Quality Improvement in Primary Care Veronica Oglesbay Davenport University HCMG Lynn Szostek, PhD November 20, Abstract Primary care is medical care provide to patient on first contact with the medical system (primary care definition). Essential primary care provide health care for most of the simply illness before the patient need reference to a specialist.
Below are two IELTS model essays for May in writing task 2. There is one essay for the Academic test and one for the General Training test. By BOB WACHTER, MD. In my last post, I discussed the role of physicians in patient safety in the US and attheheels.com, I’m going widen the lens to consider how the culture and structure of the two healthcare systems have influenced their safety efforts.