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Hserv 482 #7 Medical Care and Health. WARNING Attending this presentation may be dangerous to your perceptions of health care. Learning Objectives. Analyze a study suggesting that medical care improves life expectancy Present the data on medical harm in the US and other countries.
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WARNINGAttending this presentationmay be dangerous to your perceptions of health care
Learning Objectives • Analyze a study suggesting that medical care improves life expectancy • Present the data on medical harm in the US and other countries
Experiences with health care • Personal experiences • Family • friends
Cost of medical care • ~50% of total world health care bill is spent in the US (2005) • 2005: $1.94 trillion and 16.2% of GNP • Health care costs absorbed a 24.1 percent share of the nation's economic growth between 2000 and 2005
Health Care Insurance Profits $100 billion (2005) Sagar BU 2005
Scientific Study • Medical care has the capacity to improve mortality and quality of life
Bunker Paper looked at benefit of medical care & preventive services • on average life expectancy has increased from ~45 to ~75 years in rich countries
SUMMARY • Health care improving quality of life • ALL TOLD • 5 of 30 years life expectancy gain last century in the USA could be attributable to preventive and curative health services • FLAW?
Could medical care cause harm? • Personal experiences • Family • Friends • How would you study medical harm
Medical harm • Mistakes • Adverse or bad outcomes, • No mistakes made
medical harm a leading cause of death, wherever it has been looked atDAMAGED CARE • Studies in USA (3 states), UK, Australia, New Zealand, Denmark, Canada and France
Medical Harm • Harvard Study NEJM 1991 • Australia (1995) • IOM TO ERR IS HUMAN report (2000) • Utah, Colorado study published in 2000 • UK 2001, 2004 • Denmark 2001 • New Zealand 2002 • Canada 2004 • France (2004)
Conclusions • Getting admitted to a hospital has a risk of death from medical care approaching 1% • Varying percentage of deaths preventable, while • half or more areNOT preventable • Varying terminology: • US: errors, mistakes, negligence, iatrogenic injury, substandard care • Canada, NZ, Australia, UK, Denmark: preventability • Australia: human error
ACLS Professional Provider Manual Epinephrine "Although epinephrine has been used for years in resuscitation, there is little data to show that it improves outcomes in humans" pg 49 Highest Life Expectancy And disability free years Lowest Life Expectancy And disability free years Life expectancy disparity is 16 years
Los Angeles County Medical Malpractice Slowdown, January 1976 • 55 to 153 deaths did not occur because of the elective operations not performed because of the strike • 88 fatalities occurred among 2171 patients transferred out of the county during the strike, of which 25 could be ascribed to the strike, the remainder to ongoing “patient dumping”
OTHER DOCTOR STRIKES • Bogota Colombia in 1976 a 52-day period. The death rate went down 35% during that time. • In Israel in 1973, during a month-long strike, the death rate dropped 50%. The last time the death rate had been that low was when there was a doctor's strike 20 years before." • Croatia doctor's strike in 2003 currently being studied, clearly no decline in health
Johns Hopkins Prof. Barbara Starfield Nov/Dec 2005 and • Although the medical literature does not dwell on the damage caused by inappropriate care, several studies have shown that the third leading cause of death in the United States, after heart disease and cancer, is medical intervention, including both tests and therapies. Over the past few years, the annual number of reports of adverse effects from prescribed medications (including deaths) has been increasing. A conservative estimate of the percentage of deaths in the United States that result from adverse effects of medical treatment is ten percent. In other words, an estimated 275,000 of the total of 2.5 million deaths that are annually attributed to specific diseases are really a result of harm from interventions.
The survey was conducted by telephone from July 7 to September 5, 2004 among a randomly selected nationally representative sample of 2,012 adults 18 years or older. Interviews were conducted in English and Spanish by Princeton Survey Research Associates. The margin of sampling error is +/-2 percentage points overall. The margin of sampling error will be higher for results based on subsets of respondents. Sampling error is only one of many potential sources of error in this or any public opinion poll. Before answering questions on medical errors, respondents were all read a common definition of medical errors. They were told, "Sometimes when people are ill and receive medical care, mistakes are made that result in serious harm, such as death, disability, or additional or prolonged treatment. These are called medical errors. Some of these errors are preventable, while other may not be." Trend data is from the Kaiser Family Foundation/Agency for Healthcare Research and Quality Americans as Health Care Consumers: The Role of Quality Information (1996), The Kaiser Family Foundation/Agency for Healthcare Research and Quality National Survey on Americans as Health Care Consumers: An Update on the Role of Quality Information (2000), and the Harvard School of Public Health/Kaiser Family Foundation Medical Errors: Practicing Physician and Public Views (2002)
Public Health Textbook: • “with modern investigations and treatments, patients are now regularly saved and make very good recoveries from infections, injuries, and a variety of other conditions that were almost uniformly fatal even a few years ago.Surprisingly it is more difficult to demonstrate conclusively the impact of these medical advances on the health of whole communities” pg 238 • Detels, R., W. W. Holland, et al., Eds. (2002). Oxford Textbook of Public Health. Oxford, Oxford University Press.
Primary Care Role • Social supports for lacking for poorer segment • primary care can address • Poorer population is sicker • primary care can take of most problems
