Dr Brent C. James: We Count Our Successes in Lives: Health versus Health Care (Lecture)
Dr Brent C. James demonstrates how:
- Better care is lower cost care.
- Higher quality care has less variation, because there is less waste.
video below | slide deck summary at bottom of page
The Rule of Rescue - we have a natural human imperative to save people from suffering or death. Often we acquire case studies of heroic ‘saves’. Unfortunately as a whole such rescues are expensive exceptions to the rule, and not the normative structure of most of medicine. On a system level, it produces unsatisfactory results in overall mortally benefit.
Effects of healthy behaviours - studies from the Latter Day Saints community showed 50% adjusted mortality compared to non-LDS counterparts, and 7 years longer life expectancy. Similar results in UK study demonstrating 4x lower mortality rate and 14 longer life from no tobacco, very limited alcohol, good diet, and regular exercise.
Health insurance does not extend life - a favourite study of mine in Oregon on effects of Medicaid on clinical outcomes. Essentially, addition of health insurance did not change objective outcomes measured (BP, Diabetes, HTN, lipids, happiness, etc). (Though it did decrease healthcare spending and catastrophic expenditures).
Problem with Affordable Care Act - instead of solving the real and hard problems with American healthcare and its waste, it spread a dysfunctional system more broadly.
Fiscal Gap - don’t forget the vast majority of unfunded government liabilities relate to healthcare
1991 ARDS Bundles - a clinical process that improved survival, reduced cost, and decreased physician time. (Editorial: This by the way is the type of impact any workflow change should produce - not the typical garbage that happens in hospitals today where there seems to be increased cost, increased physician time, and it is unclear if there is better survival.
Sepsis Bundle Costs - dramatic mortality rate reduction from 21 to 8% as well as dramatic cost decreases in Intermountain Healthcare