Health reform needs a referral

Health care in the US suffers from poor delivery. Sam Wertheimer recently pointed to RAND research showing that American's only receive recommended care about 55% of the time. Sometimes that's because we just don't know what's best or decided "what's recommended," but often it's a side effect of poor systems-performance.

New research is emphasizing the need for some exceedingly basic system-wide reforms that improve the way that health care is delivered. Researchers from Indiana University and the VA have found that only 71% of patients 65 and older who receive referrals to see specialists actually get appointments, and only 70% of them show up. That means only 50% (70% of 70%) of patients in that age group who need specialist care are receiving it. After looking at over 6700 patient records, researchers concluded that there are a number of reasons for this shortfall in care: Primary care docs who fail to call the specialists, failure of specialists to receive requests for consultation, and a lack of transportation among the elderly, to name a few. Information technology holds some promise of improvement here: "Using electronic medical records and other health IT to address the malfunction of the referral process, we were able to reduce the 50 percent lack of completion of referrals rate to less than 20 percent, a significant decrease in the medical error rate," says Michael Weiner, MD, MPH, the study's lead author.

It also displays a very fundamental reason why health care reform is inextricably tied to such mundane practicalities as transportation. Even the best healthcare referral process does patients no good if they cannot get to the specialist's office. This failure to link health care with the all the other systems, structures and routines of everyday living amounts to a need for social reform, not just health reform. In health and health care it's often not a lack of skill or ability or even access that's killing us, but simply bad planning.

Photo credit: The author