Addressing the crisis in US health care: moving beyond denial
- Dennis Gillings Professor of Health Management and Director, Cambridge University Health, Judge Institute of Management, University of Cambridge, UK; Professor Emeritus and Professor of Medical Education, University of Virgina; and Member of the IOM Committee on “Fostering rapid advances in health care: learning from system demonstrations”; d.detmer@jims.cam.ac.uk
- Correspondence to: Dr G Neale, Clinical Risk Unit, University College, London, UK; g.neale{at}ucl.ac.uk
A new report published by the Institute of Medicine in November 2002 creates a “game plan” for delivering a new system of health care through a set of demonstration projects in states across the US. The goal is to see these “seeds” grow over the next decade into universally accessible, safe, evidence-based, patient centred care for the US complete with a national health information infrastructure with common operating standards, secure communications, decision support, and knowledge management.
The US healthcare system is in a crisis and it is finally acknowledging this reality. Like other nations around the world, US health care faces mounting problems including rising costs, challenges to access to services, and persistently wide variations in safety and quality. Following the failure of the first Clinton Administration in the early 1990s to reform the US healthcare system through a complex “top down” approach and the managed care belt tightening of the past decade, no basic reforms have occurred. Meanwhile the population has aged another decade, causing a much greater need for integrated care to manage chronic illness, in addition to large increases in personal body mass. Efficiency measures such as robust information networks have scarcely penetrated to the level of primary care. Despite these many shortcomings, the nation has been slow to acknowledge that the healthcare Emperor is naked except for some high technology epaulettes sewn onto a backless examining gown.
In the 1980s and early 1990s Secretary of Health and Human Services Thompson, then Governor of Wisconsin, concluded that the nation’s social welfare system was hopeless and too expensive, and he led the national reform through a creative statewide demonstration that then spread across the nation. In mid June 2002 he concluded the same about the current non-system of health care in the USA. He asked the Institute …
