Public health officials in California are looking into hospitals claiming to be free from any medical errors. Almost 90 facilities have had no significant mistakes in dispensing medical care over the past three years.
The Department of Health in California stated that 87 of 418 hospitals covered by the law, which became effective in 2007 have not made any reports detailing medical errors. With these hospitals comprising above 20% of the covered facilities, the possibility of unreported errors has been greatly considered. Several patient advocates consider this as indicating the opposition of hospitals towards self-policing. Hospitals were given a deadline by state officials to validate their error-free status or to report their errors, as required by law.
Jamie Court, the president of Consumer Watchdog, an advocacy group based in Santa Monica, considers having many error-free hospitals in three years to be “almost inconceivable.” He added that where one prefers not to look, no errors will be found; while where one chooses to look, some errors will likely be found, regardless of the bed capacity of the hospital.
The state law identifies 28 medical errors, which must be reported by hospitals to the state. These errors put patients at risk, whether it's serious injury or death. Post-investigation, fines range from $50,000, $75,000, or $100,000 for first, second, or third/subsequent incidence of errors in same hospitals. Fines up to $100 per day are imposed on delays of error notification beyond the prescribed five days within the incidence.
Since 2007 when the law on medical error became effective, 1,100 medically related errors had been reported to California government, during which it fined 112 hospitals due to medical errors, with 39 appealing.
State Senator Elaine Alquist, a Democrat from Santa Clara, the law author, expressed concern on unreported errors and questioned the probability of almost a quarter of California hospitals without errors on medication, surgery, or safety since 2007.
The hospitals without reported errors include around twelve state facilities with a total of at least 1,055 beds. Two dozen are in Los Angeles, each with less than 200 beds.
The absence of errors could have been due to the absence of surgical cases as in the case of psychiatric hospitals like the Resnick Neuropsychiatric Hospital, or the absence of obstetrics departments or emergency rooms in small facilities like the 150-bed Temple Community Hospital.
There have also been cases of incorrectly listed hospitals. The California Hospital Association’s vice president for quality and emergency services, Debby Rogers, revealed that her office communicated with all the facilities included in the list. Officials of several hospitals claimed that they have indeed reported medical errors. Rogers, however, decided not to name those hospitals.
The state law defines the preventable medical errors. However, a lot of hospital officials admit being vague on which kind of errors should be reported. Given the confusion, underreporting, over reporting, or both could occur.
To-date, the state has imposed fines on 66 hospitals for their failure to report errors. State records show that in May 2008, the San Diego Hospice and the Institute for Palliative Medicine, included in the error-free list, had been fined $12,700 for its failure to report an error in medication in 2007.
The hospital’s spokeswoman said that the incidence was not initially considered as a medically related error and the facility questioned the state’s findings. It eventually paid the fine then submitted to the state their plan of correction.
Officials of the California Hospital Association now work with California’s Public Health Department, clarifying law’s regulations and the definitions of reportable errors.
The Department has hired a faculty from the University of California with expertise in reporting public data to eventually scrutinize data on medical error and assess possible underreporting. Fines amounting to $250,000 worth taken the previous fiscal year from erring hospitals will fund the post, as the fines are money meant for patient safety.
Anthony Wright, the executive director of Health Access, based in Sacramento, stated his hopes that the list of hospitals with no errors will be verified and someday may be used to avoid the medical errors, called “never events,” as defined by the state. He added that hospitals getting zero errors should be studied in order to replicate their best practices. Wright further emphasized the need to differentiate people who institute systems to prevent the occurrence of “never events” and those who simply do not report the errors.
The Patient Protection and Affordable Care Act requires that all new health plans issued on September 23, 2010 or later must offer medical insurance coverage for preventative care without any cost sharing, copays or deductibles when performed in-network.
The services that are covered are those that have been recommended by the U.S. Preventative Services Task Force, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration.
Here is a list of the preventative services that are covered for adults:
- A preventative medical exam that is age-appropriate
- Discussions with primary care physicians regarding alcohol misuse
- Discussions with primary care physicians regarding obesity and weight management.
- One time screening for men aged 65-75 who have smoked in their past, for abdominal aortic aneurysm.
- Blood pressure screenings
- Cholesterol screenings for those adults that have a higher risk of cardiovascular disease
- Screenings for colorectal cancer for adults between 50 and 75 years of age
- Screenings for prostate cancer for men between 50 and 75 years of age
- Screenings for depression
- Screening for type 2 diabetes for adults that have high blood pressure
- Discussions with primary care physicians regarding the usage of aspirin for those adults that have a higher risk of cardiovascular disease.
- Discussions with primary care physicians regarding diet counseling for adults who also have a high risk for chronic diseases.
- Immunizations for adults (however, recommended ages, populations, and doses vary)
- Hepatitis A & B
- Herpes zoster
- Human papillomavirus
- Measles, mumps and rubella
Counseling, screening and prevention of sexually transmitted infections such as:
- Tobacco Cessation discussion with a primary care physician.
In addition, here is a list of covered preventative services for women and pregnant women:
- Preventative medical exam, which is age-appropriate
- Chemo prevention discussion with a primary care physician for women that have a higher risk of breast cancer.
- Discussion with a primary care physician about ovarian and/or breast cancer susceptibility due to family history.
- Mammogram screening for breast cancer for women between the ages of 50 and 74.
- Mammogram screening for breast cancer in other age groups, as determined jointly by physician and patient.
- Cervical cancer screening for women between the ages of 21 and 65.
- Osteoporosis screening for women 65 years old or older, and for women who are at a higher risk.
- Tobacco cessation discussion with a primary care physician.
- Screening for chlamydia infection for sexually active men and women who are at higher risk.
- Screening for gonorrhea for all women who are at higher risk.
- Scheduled prenatal office visits and first postpartum visit.
- Screening for syphilis in all pregnant women, and those women that are at a higher risk.
- Screening for anemia for pregnant women
- Screening for urinary tract infections or other infections for pregnant women.
- Screening for Hepatitis B for pregnant women at their first prenatal visit.
- Breast feeding discussion with a primary care physician about interventions to support and promote breast-feeding.
- Folic acid supplements discussion with a primary care physician for women who may plan on becoming pregnant.
- Screening for prescription incompatibility for pregnant women, and follow up testing for those women that may be at a higher risk.
Here is a list of children's covered preventative services:
- Preventative medical exam that's appropriate for the child's age
- Medical history records for all children through the years of their development
- Body mass index, height & weight measurements
- Behavioral assessments by a primary care physician for children of all ages.
- Developmental screening and surveillance by a primary care physician for all children less than 3 years old.
- For adolescents, a discussion with a primary care physician about drug and alcohol use assessments.
- Screening for autism for children at 18 months of age, and 24 months of age, performed by a primary care physician.
- Screening for cervical dysplasia for females that are sexually active.
- Screening for congenital hypothyroidism for newborns.
- Screening for phenylketonuria (PKU) for newborns.
- Screening for dyslipidemia for children that may be at a higher risk of lipid disorders.
- For young children, a risk assessment for oral health performed by a primary care physician.
- A screening for lead amongst children that may be at risk of exposure.
- A discussion with a primary care physician about screening for obesity and obesity counseling.
- Medication to prevent gonorrhea for all newborns' eyes.
- Screening for hearing for newborns.
- Screening for vision for all children.
- Screening for hemoglobin or hematocrit
- Screening for sickle cell or hemoglobinopathies for newborns.
- Testing for tuberculin amongst children who have a higher risk of tuberculosis.
- Screening for HIV amongst adolescents that may be at higher risk.
- Counseling for the prevention of sexually transmitted infections amongst adolescents that may be at higher risk.
- A discussion with a primary care physician about fluoride supplements for those children that don't have any fluoride in their water.
- A discussion with a primary care physician about iron supplements for 6-12 month old babies that may be at risk for anemia.
- Immunizations from birth to 18 years old (recommended populations, recommended ages and doses vary):
- Haemophilus influenza type B
- Hepatitis A
- Hepatitis B
- Human papillomavirus
- Inactivated poliovirus
Due to the global economic recession, Americans have cut back their usage of routine healthcare much more than people living in nations with a universal medical care system.
The National Bureau of Economic Research, who conducted the study, says that people living in the U.S. have cut back on their healthcare much more than residents of Canada, Britain, Germany and France because of the higher out of pocket costs Americans face.
In each of the five countries, residents had unemployment and lost wealth and income due to declining stock prices. This caused residents in each country to have less routine care. However, Americans used far less routine care compared to other nations because approximately 15% of Americans do not have medical insurance, and the other countries have near universal medical coverage.
According to the report, 26.5% of Americans that responded to the survey said that they reduced their usage of routine healthcare since the global economic crisis began in 2007. However, for other nations the percentage was much lower. In Canada it was 5.3%, in France it was 12%, in Germany it was 10.3% and in Britain it was 7.6%.
People who live in nations with universal coverage have to pay some health care costs out of their own pockets. The percentage of people that reported reducing routine healthcare was lower in Canada and Britain, where the copays are lower, compared to Germany and France, where they have larger copays.
Generally speaking, the report indicated that the people that were most likely to reduce their usage of routine care were those who lost a big proportion of their wealth during the economic crisis, those with low income, and the young.
The new health care reform law forbids insurers from charging any copays or deductibles for preventative services that are recommended, such as immunizations, colonoscopies and mammograms.
This report has been consistent with the American Hospital Association's findings, which states that 70% of their hospitals reported fewer patient visits and procedures classified as "elective", as patients are forgoing and delaying care because of the recession.
A study that was just recently printed in the Archives of Internal Medicine stated that the only data that's available to consumers for judging a doctor's quality of medical care just isn't enough.
The University of Pittsburgh, the Rand Corp., and researchers at the New York based Commonwealth Fund utilized 124 indicators from Rand's Quality Assessment Tools system to figure out if there's any correlation between a doctor's characteristics and their performance.
Many times, the only data that a consumer has access to is the name of the medical school that they went to, the number of years they've had as experience, and how many malpractice claims they have had. These few available indicators are not sufficient in determining the quality of medical care that a doctor provides.
Often, the published information isn't even relevant, and at times can be misleading.
Dr. Anne-Marie Audet of the New York based Commonwealth Fund, said that standards need to be raised for data about how successful physicians are at delivering medical care. She also said that patients need to be able to access relevant and accurate data that provides a snapshot of how doctors deliver medical care based on quality measures that are clinically based.
The National Business Group on Health reported that last month, its group largely believed that they anticipate medical insurance costs to go up by at least 7 percent in 2010. 63% of businesses who replied in the survey said that they intended to raise the amount that their workers would have to pay towards their medical insurance premiums. There were 72 employers with over 5,000 workers that responded to this survey, all of which offer medical insurance to their employees via a medical insurance administrator.
Throughout much of the world, health care
systems are dynamic and flexible, responding to needs and changes as they arise. However, the United States health care system has been stuck in its present state for much of its history. Amongst the nations who are successfully making changes to their healthcare programs are Canada, the Netherlands, Australia, England, Germany, France, Sweden, Norway, New Zealand, Switzerland and Sweden. The largely quantifiable changes they are making range from the system of reimbursement for providers to the actual delivery of medical attention. Efficiency and quality are markedly improved in many cases.
One of the biggest indicators of the problems with American health care, especially when compared with other countries, is that it performs the worst of 19 countries in terms of preventing medically avoidable deaths. In fact, over a 5 year period all the 19 countries studied improved their results in this category significantly, with the exception of the U.S. which made only a 4% improvement.
Many aspects of the American health care system itself and even the American system of government are at fault for the lack of change for the better to this system that is not performing as it should. Some of the things that need to change in order to create a better system include the following.
- The healthcare system needs to be simplified. In most other countries, systems are more streamlined and simple, especially when compared to the multi-faceted American system which has a multitude of payment points.
- Universal healthcare needs to be adopted like these other nations in order to improve cost-effectiveness and overall quality. The constant debate over private versus public in American healthcare achieves nothing.
- The parliamentary systems of other countries which allow governments to make changes more quickly are much simpler. They lack the complicated, multi-tiered system of the United States which bogs down any legislation that creates controversy. Other countries have majority rules type of voting and no group with the right to filibuster.
- Most countries are less affected by outside influences. The U.S. government is subject to lobbying more so than any other country. Political campaigns in America are very costly, and therefore politicians rely on groups and businesses to help them financially. This leads to a situation where the elected official "owes" his backers. In addition, the media in the U.S. puts its own spin on controversial legislation often causing panic and anger from citizens who do not understand complicated legislation.
There are numerous examples of countries that have gone back and forth on their involvement with various industries, because of the ease of change with their governmental systems. This shows that it is not always a good thing to have systems that easily allow change. However, the complicated American government system has been blocking healthcare reforms since the time of Theodore Roosevelt. It is time to step back and take a good look at the changes that can be made to bring a less than effective health care system up to the standards of other countries.
Quality is one of the most important things to look for in your health care choices. As with many goods and services in America, quality in the healthcare field varies greatly. Some providers excel at offering high quality care while others simply do not. Finding quality healthcare is essential to your well-being and the health of you and your family.
Good healthcare is care that is timely and useful in preventing illness. Good healthcare is effective diagnosing and treatment of illness and injury. High quality healthcare is something Americans want and value, says leading research. If you choose top quality healthcare that excels, the results you get will be excellent also.
Knowing how to find and select quality healthcare, such as doctors, hospitals, medical insurance plans, long-term care and treatment, is an important part of opting for the best healthcare possible. Some tips will help you improve your chances of securing quality healthcare.
- Learn about the quality of the service provided by different healthcare providers. Because of the importance of quality in service-centered areas, many ways of tracking and evaluating quality have been devised. Companies measure the quality of their service in order to make improvements. Find out as much as you can about their results in terms of quality.
- Become an active participant in your own healthcare decisions. Your choice and input do not end when you find a doctor you like. Stay involved. Ask questions about your health. Make decisions together.
- Consider your doctor your partner in health and be sure to work with him.
- Make sure you understand why things are being done. You should know why tests or treatments are being done and what the results should be.
- Educate yourself. You can get information from the hospital, your doctor or nurse, the library or even the Internet. This will help to answer many of the questions you have about your health and provide you with things to think about to formulate new questions.
Put quality first in the decisions you make regarding your health and that of your family. Follow the guidelines above and your healthcare experiences will be ones of quality.