Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Thursday, August 21, 2008

The Commonwealth Fund Gives the US Health System a Fail

There was a really worrying assessment and survey of the US Health System released last week.

Public Views on U.S. Health System Organization: A Call for New Directions

August 7, 2008 | Volume 11

Authors: Sabrina K. H. How, M.P.A., Anthony Shih, M.D., M.P.H., Jennifer Lau, and Cathy Schoen, M.S.

Contact: skh@cmwf.org

Editor(s): Martha Hostetter


On behalf of The Commonwealth Fund Commission on a High Performance Health System, Harris Interactive surveyed a random sample of 1,004 U.S. adults (age 18 and older) to determine their experiences and perspectives on the organization of the nation's health care system and ways to improve patient care. Eight of 10 respondents agreed that the health system needs either fundamental change or complete rebuilding. Adults' health care experiences underscore the need to organize care systems to ensure timely access, better coordination, and better flow of information among doctors and patients. There is also a need to simplify health insurance administration. There was broad agreement among survey respondents that wider use of health information systems and greater care coordination could improve patient care. The majority of adults say it is very important for the 2008 presidential candidates to seek reforms to address health care quality, access, and costs.


S. K. H. How, A. Shih, J. Lau, and C. Schoen, Public Views on U.S. Health System Organization: A Call for New Directions, The Commonwealth Fund, August 2008

Report and presentations are available here:


Additionally there was another report also published that explored – in some depth – what could be done about such a dire situation – in this a presidential election year.

Organizing the U.S. Health Care Delivery System for High Performance

August 7, 2008 | Volume 98

Authors: Anthony Shih, M.D., M.P.H., Karen Davis, Ph.D., Stephen Schoenbaum, M.D., M.P.H., Anne Gauthier, M.S., Rachel Nuzum, M.P.H., and Douglas McCarthy, M.B.A.

Editor(s): Martha Hostetter


This report from The Commonwealth Fund Commission on a High Performance Health System examines fragmentation in our health care delivery system and offers policy recommendations to stimulate greater organization—established mechanisms for working across providers and care settings. Fragmentation fosters frustrating and dangerous patient experiences, especially for patients obtaining care from multiple providers in a variety of settings. It also leads to waste and duplication, hindering providers' ability to deliver high-quality, efficient care. Moreover, our fragmented system rewards high-cost, intensive medical intervention over higher-value primary care, including preventive medicine and the management of chronic illness. The solutions are complex and will require new financial incentives, changes to the regulatory, professional, and educational environments, and support for new infrastructure. But as a nation, we can no longer tolerate the status quo of poor health system performance. Greater organization is a critical step on the path to higher performance.

Full summary, full report and presentations are available here:


Taken together these two reports essentially identify fragmentation of the US health system as its major problem and the lack of technology enabled co-ordination as its biggest barrier to improvement.

Does this sound a little like somewhere rather closer to home? The details are well worth a read. I hope the Health and Hospitals Reform Commission is taking a close look to see what might be relevant to OZ!



Anonymous said...

I'm not sure it's fair to compare the US with Australia. The demographics, challenges and healthcare philosophy are completely different.

Look at PHR's for example. The US have to head towards basic entry models with no interoperability as a necessity because the majority of GP's are not computerised. As a result they are happy to look at old technology such as fax inputs.

We are the opposite, hence we need interoperable inter-compliant systems with local secure data storage. Fax inputs is like taking one step forward and 4 steps back.

I'm sick of Australia being looked at as another state of the US, we are too different and to assume otherwise would be a grave mistake.

Anonymous said...

I agree with the previous comment. Why do our bureaucrats persist looking overseas primarily to the US for health systems instead of in our own backyard?

Dr David G More MB PhD said...


If we don't listen to the lessons others have learned - carefully - we will repeat their mistakes.

Just stop imagining we have any monopoly on wisdom or common sense.


Anonymous said...

Looking is fine - but heaven's above - where would we all be if we imported rather than developed medical practice computer systems? Come to think of it - IBA Health is an Australian company that continues to grow on the world stage even although States like Victoria refused to consider the IBA solutions as a possible alternative offering for HealthSmart. There has to be a balance between import and develop locally - but getting the balance right is the tricky bit.