Misconceptions On Government Run Health Care and Quality Measurements

Ezra Klein has repeated a misconception which is common in the liberal blogosphere, often based upon a flawed article in The Washington Monthly, that the VA has the best health care around.  The problem is that many who have first hand experience with the VA, either by working in health care or by being patients, are unlikely to be mislead by such faulty statistical analysis and making such claims undermines the credibility of those promoting health care reform.

Based upon real world experience, the VA system is highly mixed. I have seen examples of both excellent care and terrible care. In many ways they are years behind. I have a number of patients who go to the VA to get free medications but also see me because the care is so poor from the VA. For example, while there is general consensus that patients who are at high risk of heart disease should have their LDL Cholesterol lowered to under 70, as this promotes reversal of blockage, I have had the VA refuse to pay for increased medications on patients once their LDL is under 100 (an older goal).  The VA also refuses to pay for newer types of insulin which are far more effective than the older but less expensive types they will pay for.

Measures of quality in health care are very poor,  making comparisons based upon such reports very misleading. They are generally measures not of what is being done but what is being reported. Most doctors in private practice do not have the time to report everything we do with regards to following protocols. The incentive payments for such reporting are typically far less than the administrative costs of reporting the data. Often insurers try to extract data from claims data but the results from this turn out to be highly inaccurate. I’ve often seen reports claim that patients have not had certain tests when the insurance company preparing the report from their claims data has also paid for the test.  Quality reports are also frequently inaccurate because of having incorrect diagnoses for the patients. Frequently they aren’t even evaluating the correct information. As I often read EKG’s at the hospital on all hospitalized patients I am submitting claims on a tremendous number of patients without being involved in thier actual care. Patients who I have had no contact with other than reading an EKG often make up the majority of patients included in reports on me. This is rather meaningless data.

The VA comes out ahead because they have a computer system set up to submit the data and they have employees who follow their instructions on submitting data. This makes their numbers look better, but has little to do with the quality of care. It is purely a measure of how often they report meeting a certain quality goal. To use the example above, often such measurements use the old standard of an LDL under 100. The VA, which follows the old standard but reports all their data through their computer system, comes out better than those of us in private practice who get the LDL in our high risk patients under 70 but do not have the computer sytems to report these results.

Many patients in the VA system report problems similar to the horror stories often told about the British system. Americans are not going to back such government run systems to replace their current coverage. Not only is it inaccurate, but it is counter productive to promote such government-run systems when nobody who is actually involved in health care reform actually advocates such a system.

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4 Comments

  1. 1
    Dave Westbarn says:

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  2. 2
    Lloyd Y. Asato says:

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  3. 3
    Dave Westbarn says:

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  4. 4
    Lloyd Y. Asato says:

    Misconceptions On Government Run Health Care and Quality … http://tinyurl.com/qwhqat

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