Poor performance and costs make healthcare reform necessary

By Liz Meszaros

Future healthcare reform is not a luxury. Rather, it is a necessity, especially when the performance and costs of healthcare in the United States are considered, said Michael V. Drake, MD.

“Our healthcare system does not perform as well as it should,” said Dr. Drake. “At least 10s of thousands of people die in this country every year, who would live if they had a healthcare system that works better.”

These data are one of the reasons the healthcare system needs reform, according to Dr. Drake. The other reason is costs: they are escalating “out of control.”

Dr. Drake, currently the chancellor of the University of California, Irvine, and soon-to-be president of The Ohio State University, addressed these issues in the Shaffer-Hetherington-Hoskins Lecture.

Why we need reform

Dr. Drake cited worldwide statistics of a measure known as “mortality amenable to healthcare,” which is a statistic that measures deaths that could have been prevented by timely access to appropriate healthcare. This statistic is measured in deaths per 100,000 population.

“Mortality amenable to healthcare is a good measure of how well your healthcare system is functioning,” Dr. Drake said.

Data are available from 19 fully developed countries, including Northern Europe, the United States, and Japan. In each of these countries, Dr. Drake said, mortality amenable to healthcare is going down. This means patients are doing better because their healthcare system is improving the way it treats patients.

However, the news is not good for the United States.

“Of these 19 countries, the United States has the greatest number of deaths in the category of deaths amenable to healthcare, at about 110 deaths per 100,000 lives,” Dr. Drake explained. “The difference is about 60% or so per 100,000, compared to France, for example. This is a non-trivial statistic. There is a huge difference in the number of people who die from treatable conditions in a year in this country compared [with] the countries in Europe that have the best healthcare.”

He added that Greece, for example, has 25% fewer deaths per 100,000 population.

“I would offer this as a real indictment of the quality of the healthcare system because this is thousands and thousands of people who –given their diagnoses, if they had that diagnosis in a different country, their likelihood of dying would be much, much less,” Dr. Drake pointed out.

What about costs?

So, the U.S. healthcare system is doing poorly by this measure, but what about costs?

Dr. Drake added that the cost of healthcare in the United States compared to other countries is at least 50% higher than that second highest among those countries, double that of many of these countries that have better outcomes.

In 1970, healthcare costs per person were about $1,000 per person per year. This rose to $9,000 or even $10,000 per person per year by 2010, he noted.

“Healthcare costs have escalated in all of those other countries as well, but we started out a little bit higher and escalated faster,” Dr. Drake added. “Our costs have gone up faster and our care has improved less.”

Healthcare costs are likely to increase, Dr. Drake predicted. “You can’t cover more people for less money,” he said. “But the idea is to bend the increased per-person cost down so it’s not quite as bad.”

All in all, healthcare reform is badly needed, Dr. Drake concluded. Modern techniques and new information and data gathering, such as registries, will help improve the healthcare system.

“The information age really has given us more information that we can use to make better decisions,” Dr. Drake said. “That will lead to a happier future for all of us.”