CHAOS AND ORGANIZATION IN HEALTH CARE

One Comment

1. Dr. Terrence McGarty says:

   November 12, 2009 at 7:14 am

   There have been a lot of books that discussed health care during the past year and one suspects that this wave will continue. The book by Lee and chaos and organization Mongan right given in health care (MIT Press, 2009) is one of the most recent. The premise of the book appears to be that the health care delivery has problems because it is in a state of chaos and organization if the order is restored by the means proposed by the authors then all things will improve. On page XI indicate specifically that "the solution is organization" and this assertion is to continue building his argument. On page xiii affirm their bid for a "organization" strongly structured delivery and is the ideal and proceed to use several examples throughout the book. Before continuing, introduce an interesting historical observation. When I spent time in and around Longwood Avenue, the area of Harvard Medical School in the 60s, actually could park my VW on the front portion of one of the hospitals. By the late 80s I had to use a multi-story garage, because what I thought was a large fee of $ 8. I used last week the gigantic underground parking building for $ 30. The authors seem to recommend that patients come to them, where they gather as a group, but the artwork is parked just the tip of the iceberg of exclusion. It is quite difficult to get patients to migrate to a single location for intermittent or routine care, are too often difficult to get, especially for a patient who would then have to take a long time already pressured schedule. The response has been the practice of single or multi-doctor. P XII at the authors speak of computer-based solutions to treat diabetes. If you look at the type – 2 diabetes, later in the overwhelming majority of cases is self-inflicted mess of s due to obesity and diet. The disease can be cured just losing weight, and there must be measures taken to make that happen, if not a cost to be applied to the patient's health and lifestyle choices of s. Assuming that nothing can be done with such a patient is just wrong and puts the costs in the rest of us to conform. Pp 39-40 In the authors begin their analysis with the data show that Medicare patients see multiple doctors each year. They have a letter showing that the diabetic Medicare patient sees several doctors to 9 which are 3 primary and 6 which are the specialists. You accept the data but one should ask. If the patient has type – 2 diabetes, then we know there are editions kidney endocrine, cardiac, neurological, ophthalmological, and possible, but if the patient through Medicare with type – 2 diabetes who believes that all this every year then this is clearly an overload on any system. The authors published this data there without adequately explaining them and let them speak for themselves. It does so well. On p. 47 the authors have a table showing the internal tests are performed no more than routine. Let me try some. First, the stress test treadmill is best done by cardiologists just in case a patient suffers an MI while try on. Not prepared to handle this general domestic and insurance could skyrocket if it was taken on, as well as the insurance company can not repay. There are many reasons why not. Now for a liver biopsy. NinguÌ? Internal n take the risk of an invasive surgical procedure in his office unless there was no alternative. Slicing an artery in the liver is a substantial risk. Part II begins on p 55 is where the authors begin their bid for the organization. Its total supply is in chapter 6 for a tightly structured organization of health care delivery, at p 97 and use the VA as an example. The essence of supply is that one can create a dense and tightly integrated delivery system and that one gets to patients coming to the system and because of efficiencies in the delivery mechanism unit costs and overall costs are reduced as well. This centralized approach is the classic of architecture in the production introduced in the 1800s. Yet one wonders if that is the only paradigm for health care delivery. In Chapter 10 on p 175 the authors detail many of the reasons for lack of change. They focus on the supplier and carefully listed the key barriers to any form of evolution. On p 184 present an interesting letter, letters of this type one can find in almost any environment, a doctor in the ER asked 40% more CAT scans then the second highest doctor ordered. Something that statistics laméntese one should try to understand why, the devil is in the details. On p 205 the authors appear to support rolling of payments, a plan that has worked its way into the existing health care accounts (2009). The liar is a natural consequence of institutionalized health care delivery. However if one can be in favor of the permanence of a distributed delivery system of medical care, which is in close contact with patients, after rolling is just another word for institutional control and reducing the autonomy of the medical and patient choice. It's a sticky issue and the authors do credit to both sides. On p 229 in the final chapter the authors stress that the organization of suppliers is essential for change. They also seem to promote single payer system approach at p 237. The problem is that no business or financial analysis of tenders. There are many generalizations and many anecdotes but frankly not a single analysis and what would be obtained by defined actions. I return to the metric we used earlier, namely that for any specific disease that we have the total costs being: Proceedings of the total incidence of Costs = Population X X X patients by cost per procedure So we can look at costs as led by the four elements above. We see a growing population and thus no influence there. We can reduce incidence. Smoking has been reduced by taxing cigarettes and we've seen in a reduction in the incidence of male lung cancer. Yet the one hand we see a massive explosion in obesity and the resulting type – 2 diabetes. Much can be done in incidence. In procedures, for acute coronary syndrome and the like now have many procedures that we do today we could not do 40 years ago and have reduced mortality to 50% accordingly. Is that good, if we perform these procedures. Then finally the cost per procedure. The last element is what the authors appear to talk. What are they and how do their offerings and reduce costs by much. The devil is in the details, and more importantly in the numbers. It is with the numbers we are the authors very briefly. The book is far too anecdotal and lacking way too elaborate. Rating: 3 / 5 Chaos and health care organization