How health reform is like accident reform

“Do you know how many people died in car crashes in the United States in 2010? 32,000. That’s the lowest number since 1949. That’s impressive, but wait: It’s far more impressive than it sounds at first, because people in the United States drove about 10 times as many vehicle miles in 2010 as they did in 1949. In other words, if you drove a car or truck in 2010, you were 10 times more likely to live through each mile you drove than your father or grandfather was 60 years ago.

Why? Are we better drivers? Nah. Seatbelts, airbags, tougher DUI laws, breathalyzers, graduated licensing for teenagers, anti-lock braking systems, better highway designs, crash barriers, rumble strips, median barriers, steel-belted radial tires that don’t blow out, crumple zones, better bumpers…system tweaks that work, that make it 10 times as hard for even a terrible driver to kill himself or you.”
–Joe Flower, How to Blow the Big One: A Methodology

With his comments on the reasons behind the dramatic drop in highway deaths, Joe Flowers, a prominent health analyst, has given us a useful metaphor for health reform.

In many ways, health system reform is like accident reform. Both travel along the highway of life.

  • Every citizen, from the young to the old, is involved in one way or another.
  • Accidents are common and costly and mostly occur close home.
  • Concrete highways and information highways link us all.
  • Systems engineering of cars and hospitals can be made safer.
  • Government can serve as catalyst , e.g, building and maintaining an interstate highway system or introducing health exchanges in states.

A myriad of little things introduced on a broad scale over time, engaging all of us, can and will make a big difference between disabilities and premature death and a productive full life.

A lot of these sometimes seemingly disconnected things are occurring right now. Some are apparent, others are not so obvious, but all are part of the big picture of a rolling national reform effort.

  1. Hospitals are introducing safety features – pre-surgical checklists, protocols for infection control, standards for ICUs, measures of comparative outcomes. And, just as importantly, they are decentralizing their operations with freestanding ERs and outrach clinics and surgical and diagnostic units. new roads geographically nearer to patients.
  2. Physicians are installing websites and otherwise computerizing to address payer and patient concerns. They are introducing technologies – portable ultrasounds, implanted monitoring devices, predictive cardiopulmonary equipment to spot chronic disease early. Meanwhile telemedicine and electronic communication, especially mobile hand held gadgets, are broadening and deepening and patient-doctor relationships. Information technologies are changing the fundamental nature, of office practices and their connections hospitals, and patients.
  3. Patient empowerment and engagement is flowering as 80% of patients have Internet access, either at their homes, at work , or in local libraries, and as 80% of citizens use the Internet to search for health information. In the process disease and health care is being demystified, but it is being distorted too by misinformation. Most patients still trust their doctor to separate the wheat from the chaff. Patients are making it clear they prefer decentralized, noninvasive care and self-care, particularly in their homes surrounded by loved ones and family.
  4. The world of technology and innovation is responding to the needs of reform in multiple ways – by developing mobile devices with multiple apps, and by using data analytics to focus on where the greatest needs are, what patients are generating the most costs, how online real time information can facilitate more efficient and effective care, how robotic surgical machines can supplement human surgical skills, and how the information highway can interconnect everybody across the health care landscape.
  5. The government, through health care legislation, is trying to serve as the mastermind, guide, and catalyst for reform efforts for the various sectors. But government dictation of care faces tricky tasks– how to standardize and connect care across a diverse landscape without overwhelming society with suffocating and counterproductive regulations without increasing costs. This is not easy in a society that increasingly distrusts government, particularly big government far removed from the local scene. As Joe Flower has observed: “Reform is not the change. The federal health care reform law is a catalyst, and enabler, and an accelerator of the change we are going through. It is not the change itself, and is not even the cause of it, because the change is driven by much larger economic and demographic factors, especially by the crushing cost of health care. If the reform law were to go away, the change would not go away.”

The highway to health reform is paved with good intentions but it has many byways and roadblocks. Thanks to the commitment and engagement of multiple sectors of American society, it is headed in the right direction. As a result of health care reform, consumers, doctors, nurses, hospitals and decentralized health facilities across the country are innovating to reduce costs and errors, end duplication and waste, deploying technology to safely share information, and coordinate care between practitioners and settings.

Health reform is on a roll on multiple fronts. Patient crashes are going down. Don’t let the road noise bother you.

Richard Reece is the author of Obama, Doctors, and Health Reform and blogs at medinnovationblog.

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  • Alice Robertson

    And almost as many people will die from pharmaceutical overdoses as car accidents?  We can add mandatory schooling to the soon-to-be-regulated list of doctor’s to-do list or they will not be able to prescribe pain killers.  The difference with the metaphorical car accident is how our health insurance is paid for…..meaning rarely will Medicaid patients get the true help they need when they rely on ER visits, etc…….same as Medicare which will allow the government to budget away life….something private insurers would be regulated against doing (yet, probably do…because…gosh…we all know it’s illegal to ration healthcare…just turn a life into a dollar sign).   There is just such a vast difference between auto insurance and medical insurance…and it seems the healthcare insurers will be required to do items that the auto insurers aren’t (i.e. pre existing conditions….with two children who have/had cancer I should embrace this…yet, it seems as if the government is telling insurers that someone can have no insurance and have an automobile accident THEN buy insurance after they screw up….but there are levels of pre existing conditions and some of them are consequences and some are just random…not blame….they just happen).

    I guess I am flustered that doctors and hospitals didn’t just take the initiative and improve without all this government force….it seems they shot themselves in the foot with their own irresponsibility….and now, patients have also.

  • Donald Bryant

    I understand that care in hospitals is improving dramatically but it seems that the care from primary care sites is just beginning to change and go in the right direction.  At the primary care level it seems we are going 40 mph in a 70 mph zone.  Very frustrating!  However, changes are beginning to take hold, I am convinced.

  • don peterson

    Parallels between accident reform and healthcare reform may appear as similar forces to move outcomes in the proper direction, except for one BIG factor: people.  Drivers are generally inclined to avoid accidents. Technology and new rules and regulations may make it 10x less likely for even a bad driver to kill himself but in healthcare no technical breakthrough, or rule or regulation, no new insurance schema, no research is going to alter the behavior of patients to avoid disease.  In fact, our population is inventing ways to kill itself that no new cancer drug or cardio-vascular procedure will avert.  One in 3 Americans is today obese and it is projected that before 2030 half of all people will be obese. Obesity is just a risk factor but it is a well-known risk associated with lots of ways to die.  Moreover, obesity will lead to slow progressing, debilitating diseases that will languish for years, maybe decades.  The cost of treating the obese will likely exceed today’s cost of treating cancer or heart disease. 

    It’s not unusual to hear an M.D. talk about science and technology as if health and well-being are tied directly to advances in treatments and care. But unlike automobile accidents, doctors can build a better bus and those riding on it may be safer, but that doesn’t stop pedestrians from stepping in front of it as it hurdles down the boulevard.

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