Health Care in the 21st Century
http://www.100md.com
《新英格兰医药杂志》
To the Editor: In his Shattuck Lec ture on health care in the 21st century (Jan. 20 issue),1 William Frist takes pride in the "tough but wise dec isions" by America's leaders that "unleashed the creative power of the competitively driven marketplace," promising to bring "lower costs, higher quality, greater efficiency, and better access to care" by 2015. Frist's confidence seems strangely misplaced, since it is precisely this marketplace model that has brought us our currently escalating health care costs, shrinking access to care, and mounting dissatisfaction on the part of patients and the medical profession alike. We in the United States are unique in the world in regarding health care as a commodity, and as a consequence, we spend more for health care than any other country does. At the same time, the United States ranks 37th in quality of service, according to the World Health Organization, and 27th in rates of infant mortality, and our life expectancy is shorter than that in several European countries that spend far less on health care. This is hardly a record that merits such praise and confidence in our system. Rather, it is one that should call into question the industrial model that, Frist maintains, holds such promise for our future health care.
Victor Gurewich, M.D.
Beth Israel Deaconess Medical Center
Boston, MA 02215
vgurewic@bidmc.harvard.edu
References
Frist WH. Shattuck Lecture health care in the 21st century. N Engl J Med 2005;352:267-272.
To the Editor: Dr. Frist's vision of health care in the 21st century is imaginative but risky. His reliance on "consumer-driven health care" threatens to exacerbate the inequalities and inefficiencies in U.S. health care. His call for "affordable health coverage for all Americans" does not equal affordable health care for all Americans. High-deductible insurance with health savings accounts is less expensive than traditional coverage, but the financial barriers with this approach discourage primary and preventive care.1 If his fictitious patient, Mr. Rogers, had a low or moderate income, he might question, while having chest pain, whether he could afford "nanocath" laboratory services.
Instead, everyone should have an inviting medical home2,3 where they can get the care they need. We should make high-quality information more available to patients, but the burden of reducing costs should be focused on policy makers, hospitals, and clinicians through a realignment of care incentives. We encourage Congress to follow the recent recommendations of the Institute of Medicine by "taking action to achieve universal health insurance . . . with enactment by 2010."4
Jeffrey Huebner, M.D.
University of Washington
Seattle, WA 98105
eino@u.washington.edu
Kenneth Frisof, M.D.
Case Western Reserve University
Cleveland, OH 44106
References
Half of insured adults with high-deductible health plans experience medical bill or debt problems. Washington, D.C.: The Commonwealth Fund, January 27, 2005. (Accessed April 14, 2005, at http://www.cmwf.org/newsroom/newsroom_show.htm?doc_id=257751.)
Martin JC, Avant RF, Bowman MA, et al. The future of family medicine: a collaborative project of the family medicine community. Ann Fam Med 2004;2:Suppl 1:S3-S32.
Levine S. District health system faulted. Washington Post. January 29, 2005:B1.
Institute of Medicine. Insuring America's health: principles and recommendations. Washington, D.C.: National Academies Press, 2004.
To the Editor: Rodney Rogers of Woodbury, Tennessee, could have been one of the 323,000 people eliminated from TennCare (the Tennessee Medicaid program) as a cost-saving measure back in 2005. His myocardial infarction in 2015 might have been prevented if he had had access to care 10 years earlier. Where is the "common-sense efficiency" Dr. Frist details in the current spate of Medicaid reductions?
Rosemary M. Harris, M.D.
Drexel University School of Medicine
Philadelphia, PA 19129
rh39@drexel.edu
To the Editor: Nothing less than creative, strategic thinking is needed to improve our nation's health care system. Dr. Frist's vision crystallizes many of the forward-thinking ideas currently under discussion by leaders across the health care and political spectrum.
The American Medical Association is deeply concerned that without action our health care system will crumble. Through leadership, education, and advocacy, we are working to expand coverage to the nation's uninsured, reform our broken medical-liability system, ensure fair payments to physicians participating in Medicare and managed-care programs, improve the quality and safety of care for our patients, and improve public health.
John C. Nelson, M.D., M.P.H.
American Medical Association
Chicago, IL 60610
Victor Gurewich, M.D.
Beth Israel Deaconess Medical Center
Boston, MA 02215
vgurewic@bidmc.harvard.edu
References
Frist WH. Shattuck Lecture health care in the 21st century. N Engl J Med 2005;352:267-272.
To the Editor: Dr. Frist's vision of health care in the 21st century is imaginative but risky. His reliance on "consumer-driven health care" threatens to exacerbate the inequalities and inefficiencies in U.S. health care. His call for "affordable health coverage for all Americans" does not equal affordable health care for all Americans. High-deductible insurance with health savings accounts is less expensive than traditional coverage, but the financial barriers with this approach discourage primary and preventive care.1 If his fictitious patient, Mr. Rogers, had a low or moderate income, he might question, while having chest pain, whether he could afford "nanocath" laboratory services.
Instead, everyone should have an inviting medical home2,3 where they can get the care they need. We should make high-quality information more available to patients, but the burden of reducing costs should be focused on policy makers, hospitals, and clinicians through a realignment of care incentives. We encourage Congress to follow the recent recommendations of the Institute of Medicine by "taking action to achieve universal health insurance . . . with enactment by 2010."4
Jeffrey Huebner, M.D.
University of Washington
Seattle, WA 98105
eino@u.washington.edu
Kenneth Frisof, M.D.
Case Western Reserve University
Cleveland, OH 44106
References
Half of insured adults with high-deductible health plans experience medical bill or debt problems. Washington, D.C.: The Commonwealth Fund, January 27, 2005. (Accessed April 14, 2005, at http://www.cmwf.org/newsroom/newsroom_show.htm?doc_id=257751.)
Martin JC, Avant RF, Bowman MA, et al. The future of family medicine: a collaborative project of the family medicine community. Ann Fam Med 2004;2:Suppl 1:S3-S32.
Levine S. District health system faulted. Washington Post. January 29, 2005:B1.
Institute of Medicine. Insuring America's health: principles and recommendations. Washington, D.C.: National Academies Press, 2004.
To the Editor: Rodney Rogers of Woodbury, Tennessee, could have been one of the 323,000 people eliminated from TennCare (the Tennessee Medicaid program) as a cost-saving measure back in 2005. His myocardial infarction in 2015 might have been prevented if he had had access to care 10 years earlier. Where is the "common-sense efficiency" Dr. Frist details in the current spate of Medicaid reductions?
Rosemary M. Harris, M.D.
Drexel University School of Medicine
Philadelphia, PA 19129
rh39@drexel.edu
To the Editor: Nothing less than creative, strategic thinking is needed to improve our nation's health care system. Dr. Frist's vision crystallizes many of the forward-thinking ideas currently under discussion by leaders across the health care and political spectrum.
The American Medical Association is deeply concerned that without action our health care system will crumble. Through leadership, education, and advocacy, we are working to expand coverage to the nation's uninsured, reform our broken medical-liability system, ensure fair payments to physicians participating in Medicare and managed-care programs, improve the quality and safety of care for our patients, and improve public health.
John C. Nelson, M.D., M.P.H.
American Medical Association
Chicago, IL 60610