The first article I wrote explained that implementing a Universal Health Care System, through a non-profit, single payer, private health insurance agency can save us one trillion dollars per year. That is more than what we spent on the wars in Iraq and Afghanistan since 9/11. This system saves our economy a minimum of a trillion dollars each and every year.
Since its publication on The Huffington Post, there have been a number of mostly positive comments about this article. One person however, stated "Low cost is good, but what about quality of care?"
Today, I am going to address the issue of the quality control in the proposed non-profit, people-funded, people-managed Universal Health Care System. I am very sensitive to the quality control issue because for 40 years, as a physician in the system, I have struggled with it.
Our present health care system is a hodgepodge of various health insurance companies, HMOs, hospitals, doctors, etc. In this system a good deal of effort is devoted to practice "Defensive Medicine" in order to avoid malpractice suits. If you have ever visited a hospital, you might have noticed that there are more people hustling and bustling in the nurse's stations writing and dictating records than they are in the rooms taking care of the patients.
This extensive record keeping is to make sure all the records are in order for avoiding malpractice suits and justifying the expensive billing. The only quality control regimen in place in the present system is through the hospital committees, replete with "You scratch my back, I'll scratch yours - and don't make waves" mantra. This crony system is not an effective quality control regimen.
Today, 80,000 patient deaths per year are attributed to medical mistakes as admitted by the present health care system. This staggering number is more than double the number of people killed in car accidents each year, and more than 20 times the total loss of life in the Iraq and Afghanistan wars. Even this high medical mistake death rate is most likely an underestimate, because of the "Defensive Medicine" record keeping and cronyism prevalent now. I know this well as a physician with 40 years of experience.
Malpractice awards will never replace your eye or limb, your child or your mother. It is the cost of doing business. Its cost is ultimately passed on to policy holders and tax payers. Doctors, hospitals and insurance companies continue to do their business as usual. Today, our health care system is less regulated and quality controlled than AIG or the stock market. It is no wonder that it may take our country into bankruptcy in a few years.
Now, let me address the quality control regimen, as suggested in my book "Universal Health Care System for the United States of America" (available for free here). If enacted, this proposal will create an unbiased quality control regimen for our health care system for the first time.
Quality control: Doctors, nurses and other service providers would be given an identity number used for the purpose of unbiased evaluation by their peers. They would be evaluated for their performance according not only to the standard of care guidelines, but by feedbacks from their patients, as well as other professionals in their field. They would be evaluated by other doctors, nurses, etc.
The evaluating doctors and other professionals would be blind to the identity of the doctor, nurse or other providers that they evaluate. This approach maintains objectivity and avoids cronyism during evaluation. The final evaluation score will be the result of a combination of patient satisfaction and objective peer review evaluations. This form of evaluation would be strictly guided by what is best for the patients and not what is the least costly care (as it is now prevalent in many HMOs) .
Further quality control: All surgeries would be digitally recorded and archived. The recording would later be used for quality and performance evaluations of each particular surgical team. Surgical teams are assigned a number for blind evaluation. Furthermore, these archives of procedures would be available for medical education and to lawyers for malpractice suits resulting from negligent performances. Malpractice awards would be paid by the agency and not by individual doctors and providers. The individuals involved maybe reprimanded, re-educated or dropped by the health insurance agency. The code for the identity of individuals of the surgical team would be opened only to the highest management in cases of malpractice settlement involving judgment for the purposes described above.
Who are the evaluators? The evaluators would be selected randomly from physicians, nurses, or other providers. They will be compensated for their time at the same rate as they receive payment for serving patients. They would work only as part time evaluators on a time-limited, rotating basis and would be blind to the identity of the professionals they evaluate.
This quality control regimen is the first approximation of what needs to be done. There will be no doubt many refinements and alterations brought into it if we are lucky, with your help, are able to implement such a cost effective and humane health care system.