March 1,2001 Updated 11:13 AM ET
Report: Nation's health care woefully lacking. More on health care
WASHINGTON (AP) - The nation's health care system is a
tangled maze that too often leaves Americans with inadequate, outdated, even unsafe therapy, according to a scathing report Thursday that recommends an
urgent overhaul to bring 21st century care to more patients.
U.S. specialists know sophisticated and effective ways to
fight killers like diabetes, heart disease and breast cancer. But too many
patients slog from doctor to doctor in search of one who can even fit a
basic physical examination into their crowded schedules, much less one who
understands and uses the best treatments, says the report by the Institute
of Medicine.
"The frustration levels of both patients and clinicians
have probably never been higher," the report says. "Health care today harms
too frequently and routinely fails to deliver its potential benefits."
The report is a follow-up to the institute's
groundbreaking 1999 announcement that medical mistakes kill from 44,000 to
98,000 hospitalized Americans a year. While some scientists quibble with the
toll, that report has sparked major changes as hospitals nationwide adopted
new programs and technology to cut mistakes.
The new report looks at overall health systems, from
private doctors' offices to insurance. The institute, a private organization
that advises Congress on scientific matters, recommends an overhaul toward
patient-focused health care that gives Americans more information about
their health and makes more doctors follow the latest scientific evidence
instead of outdated treatments.
It urged Congress to set aside $1 billion over the next
three to five years to boost programs that would spur such change.
Another big recommendation: If someone gets sick late at
night or on a Saturday, and it's not an emergency, they still should be able
to get care, even if all they need is a doctor's e-mail recommending
self-treatment.
That represents "a fundamental shift in the culture of
medicine," Dr. Kenneth Kizer of the National Quality Forum, a nonprofit
health improvement research group, said after reviewing the recommendations.
Round-the-clock care access in particular has been ignored by doctors simply
because "it was not a priority. We need to make it a priority."
"The medical establishment will have trouble with this,"
predicted Dr. Lucian Leape of Harvard University, a co-author of the report.
But "patients fall through the cracks," he said, and "it doesn't have to be
that way. There are ways to make it possible for patients to be taken care
of promptly and efficiently and not break the bank."
One of the report's most alarming findings: It can take 17
years for important research discoveries to become accepted and used by the
average doctor. Heart medicines called beta blockers, for example, were
proved more than 10 years ago to increase significantly a person's chances
of survival after a heart attack. But nearly half of heart attack victims
still don't receive them, Leape said.
Other problems: Women forced to wait nine weeks for a
biopsy after a suspicious mammogram; patients denied access to their own
medical records, so that they can't weigh treatment options; paper medical
records that emergency rooms can't get during a crisis and that are easily
lost when patients switch doctors; sufferers of complicated chronic
illnesses bounced from specialist to specialist who don't coordinate their
care.
The health payment system can discourage doctors from
doing the right thing, the report said. It cited physicians who give
high-quality care that controls diabetics' blood sugar only to see their
incomes plummet as those patients' need for more expensive care declines.
Insurance companies pocket the savings.
Patients should receive care whenever they need it, 24
hours a day, and not have to wait months for a nonurgent doctor visit or
head for the emergency room, the institute said. That doesn't always mean
face-to-face visits, it said, urging more doctors to e-mail patients or set
up telephone consultations. It also recommended that insurers cover such
care.
Nor should treatment vary illogically from doctor to
doctor, the report says. It suggested that the government identify 15 of the nation's most problematic diseases and establish care standards for them
within five years.
Copyright 2001 Associated Press. © Copyright 2001 USA TODAY -- Marta Russell