Wednesday, November 5, 2014

Uncertain Health in an Insecure World - 7

"What’s in a Word?"

The counterpoise of chronic disease management with acute Ebola outbreaks confuses developed world health systems.

The emerging Hobson's choice question for their patients is:
Q: Would you rather die in hospital at age 75 after thirty years of chronic disease, or die acutely in a hospital at age 45 within three weeks after contracting Ebola?

The unsatisfying answer to this tricky question is:
A: Most of the >750,000 staffed U.S. hospital beds are configured for acute (not chronic) patient care, and there are currently only 11 U.S. hospital beds judged Ebola care ready by the CDC.

To health care systems in the developed world, and now in the less developed world, there is no question as to which type of death is more cost-effective... It's Ebola.

Degraded in common usage by medical half-truths and media spin, health care confusion abounds.

So let's clear up a few of the words in the cloud...

Contamination: Medical providers who don gowns, gloves & masks for routine patient care face an immense risk of self-contamination when removing similar gear after caring for an acutely ill Ebola patient. Daily use of acute (intubation, surgery) and chronic (dialysis) life-saving measures are known risks for Ebola virus spread via contaminated body fluids. Complex decontamination protocols are much more robust than simple aseptic techniques (hand washing) for acute and chronic patient care.

Isolation: Protective isolation of medical care providers against acute (meningitis) and chronic (tuberculosis) infections is not the same as reverse isolation of patients with weakened immune systems. The near-certainty that an Ebola-infected person walking into the emergency room of a nationally-accredited metropolitan hospital will be promptly ‘isolated’ is ironically coupled with high probability that these less specialized medical facilities cannot reliably treat this illness.

Transmission: Unlike the obvious blood splatter from an open wound onto surgical scrubs, Ebola transmission is typically subtle – the virus unwittingly borne by caregivers and their personal contacts – coworkers, families, passengers (and yes, possibly their pets). Most Ebola victims cannot say how they became infected. Public health experts’ disease control and index case containment efforts are not the same as government-mandated or self-imposed personal quarantine.
Spending: Some of the world’s most expensive (cost per capita) health care systems struggle to control their ever-escalating acute & chronic care expenses (by “bending” national cost curves) through purchasing groups (by 'commissioning' in the UK) and incentives (by 'pay-for-performance' and 'accountable care' in the US). Looking in the mirror, the public health care system reality sounds more like, “We just buy things… We don’t do quality”.

Investing: Some of the world’s most improved and cost-effective public health care systems, such as New Zealand, have “devolved” their cost-control strategies. Their new modus operandi reflects a national belief that “Spending is palliative, while investing is hard-nosed”. Private sector investing in public health care is controversial. However, it is undeniable that such strategic partnerships - with the partners sharing financial “skin in the game” - are a powerful incentive for value creation.

The forecast is for word cloud clearing!

Plain talk is echoing across in The Square.

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