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For all of the fanfare that came with late Julys Secretarial Summit on Health IT in Washington, D.C., we are unlikely to see vast improvements in our nations health care system anytime soon. Dont get me wrong, Im a fan of electronic medical records, computerized order entry and, in general, the whole shebang.
But while health IT promises to save lives and cut costs, we should not fool ourselves into thinking that its the biggest health care issue, let alone a panacea.
Consider:
- The number of uninsured Americans rose nearly 15 percent from 2001 to 2002, the latest figures available, here in PDF form. That means 43.6 million Americans—more than one in 10—lack health insurance, according to the U.S. Census Bureau.
- A Harvard study found that Americans paid nearly $300 billion dollars more than Canadians in health care bureaucracy in 1999. This does not merely reflect the larger U.S. population. U.S. administration costs per capita were $1,059, more than three times those of Canada at $307.
Overhead in Canadas provincial insurance plans averaged 1.3 percent, versus 11.7 percent for private insurers in the United States and 3.6 percent for U.S. Medicare. While switching from paper to electronic systems might bring down these costs, the waste can be attributed to a grossly inefficient, multipayer system.
- The United States spends a far greater percentage of its gross domestic product on health care than other rich nations (15 percent versus 9 percent) and, according to The Economist, the gap has been widening for the past three decades.
- This could be justified if higher costs brought greater benefits. Unfortunately, the evidence suggests that they dont: Life expectancy at birth in the United States lags behind that in Japan, France, Italy, Australia, Sweden, Germany and Britain.
Solving these problems means tackling complex issues and powerful interest groups. Announcing new health IT programs does not, and its much better at grabbing headlines.
And even if new programs move beyond proposals and plans, they will not have been in place long enough to be assessed in time for the November elections.
Indeed, even the proposed health IT policies dont represent many definitive steps. “Bear in mind, this is not a full-blown strategic plan,” health IT czar David Brailer said when releasing the progress report. “It is a broad concept of where we want to go. It leaves a lot of space open to let the industry fill in details.”
At the summit, the Department of Health and Human Services announced $2.3 million in funding across nine communities. Yet Evanston Northwestern Healthcare estimated that its move to a fully integrated electronic health system cost $30 million. (Though electronic systems are expected to result in savings eventually, they require large upfront investments, and IT managers frequently cite lack of a strong business justification as a difficulty).
A recently released survey compared the least-wired hospitals to the most wired. Four-fifths of the most wired have bedside access to drug-interaction alerts, but less than one-fifth of the least wired do. Sixty percent of the most-wired hospitals have a physician dedicated to IT training, compared with 3 percent for the least wired.
Surely this has as much to do with the amount of resources as the allocation of resources at any given hospital? In announcing this funding, the administration put forth one specific plan to encourage health IT adoption. The rest? Big, airy ideas.
But thats a minor quibble. More significantly, before we design a 10-year plan to organize electronic medical records, maybe we need to make sure we have a 10-year plan to provide affordable medical care. IT is only a part of the solution.