Re: Avoiding Avoidable Care Conference (2-3)
Editor's note: In an effort to reduce the number of mailings, we have combined messages from Enku Kebede-Francis (2) and P. K. Sishodiya (3).
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(3) - From: Dr. P. K. Sishodiya (pksishodiya@yahoo.com)
Thanks for raising this issue.
At least in India it is no secret that most corporate hospital are fleecing the emerging middle class by unnecessary so called health care by scare mongering. Entering some of these hospitals with minor ailment like cough and cold will make you poorer by few thousand rupees. Families have been ruined by unnecessary investigations and treatment. Of course one major factor has been poor and overcrowded public health care. By and large most Indians do not visit doctors or hospitals unless it is absolutely necessary. But once they enter these corporate health care factories, they are in trouble to no end. The situation is further complicated by medical insurance, if you are under insurance you are bound to be hospital much longer than otherwise for the benefit of the hospital and not that health care is required or necessary.
Dr P K Sishodiya
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(2) - From: Enku Kebede-Francis, PhD, MS, MEd (Enku.Kebede_Francis@tufts.edu)
Dear Members,
The flip side of this conference is ‘not avoiding non-avoidable care’. By this I mean many die from preventable diseases in developing countries and many do not have access to basic necessities. As you all know NCDs are no longer limited to developed countries but they are also becoming prevalent in developing countries. How will they manage the triple burden of NCDs, lack of universal access to primary healthcare and lack of universal access to clean water and improved sanitation? It will require committed governments and good governance in health to reverse the trend.
Best wishes,
Enku Kebede-Francis, PhD, MS, MEd
Assistant Professor: Tufts University School of Medicine
Department of Public Health and Community Medicine
Adjunct Scientist:
Jean Mayer-USDA-Human Nutrition Research Center on Aging
136 Harrison Avenue
Boston, MA 02111
617 636-2714
617 636-4017 (Fax)
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(1) - From: Sandeep Saluja (doctorsaluja@gmail.com)
Thanks for the valuable and timely comments.
My feeling is that one of the problems lies in the way we think any patient should be treated. Textbooks of medicine lay down what appears to be ideal form of care and all medical students and experts feel that a certain protocol which is laid down in textbooks is the gold standard and then when one is asked to draw a protocol for resource limited area,one tries to do the same thing minus the expensive things. This is wrong!
One needs to appreciate that treatment protocols need to be redrawn for different circumstances. It is not that everyone should wear a three piece suit. Those who can not afford, can do still do the same minus the coat. Those who can not afford that can do minus the pant and so on. In fact, a traditional attire of say kurta and pyjama may be as good as a three piece suit. There is no gold standard.
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Original message - From: ProCor (procor@list.procor.org)
Dear subscribers of ProCor,
The Lown Foundation just concluded a major conference called "Avoiding Avoidable Care". This was an invitation only gathering of leaders in American medicine focused on the causes and cures for the large amount of unnecessary care that occurs in the US health care system. Keynote speeches were delivered by Harvey Fineberg, President of the Institute of Medicine, Donald Berwick, the founder of the Institute of Healthcare Improvement, (and until recently, the Administrator of the Medicare program), Dean Julio Frenk of the Harvard School of Public Health, Secretary of Health of the Commonwealth of Massachusetts Dr JudyAnn Bigby, and of course, Dr Bernard Lown.
There is clearly a growing movement towards defining and reducing the enormous amount of clinically ineffective waste in the US health care system, but judging from the comments we have been receiving and the coverage from the news media, we may have reached a significant tipping point. One can only hope so. The model of excessive, hi-tech care being adopted by the health care industry of low- and middle-income countries, and offered primarily to the emerging middle classes in the large cities represents a major opportunity cost for their societies. I know for a fact that in India, the private system of health care extracts significant amounts of wealth from people without giving equivalent value in exchange. This is an open secret outside the circles of polite conversation, but remains something that needs more attention.
I have maintained for years now that the huge amount of waste in the US and abroad represents a vast pool of resources that could be applied to extending coverage for other types of health care services, particularly preventive care and public health initiatives. The public health community and public health in general has been the victim of this misallocation of capital, and the perennial discussion about where to find scarce resources for prevention would have a different character if we were to take this issue into account.
Please visit www.avoidablecare.org to look at the details. We'll be making video of Dr Lown's speech available online when we have it. Dean Frenk's remarks, and those of many many others will also be published online over the next several days.
We welcome your reaction and comments.
Vikas Saini
President, Lown Foundation
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(3) - From: Dr. P. K. Sishodiya (pksishodiya@yahoo.com)
Thanks for raising this issue.
At least in India it is no secret that most corporate hospital are fleecing the emerging middle class by unnecessary so called health care by scare mongering. Entering some of these hospitals with minor ailment like cough and cold will make you poorer by few thousand rupees. Families have been ruined by unnecessary investigations and treatment. Of course one major factor has been poor and overcrowded public health care. By and large most Indians do not visit doctors or hospitals unless it is absolutely necessary. But once they enter these corporate health care factories, they are in trouble to no end. The situation is further complicated by medical insurance, if you are under insurance you are bound to be hospital much longer than otherwise for the benefit of the hospital and not that health care is required or necessary.
Dr P K Sishodiya
-----
(2) - From: Enku Kebede-Francis, PhD, MS, MEd (Enku.Kebede_Francis@tufts.edu)
Dear Members,
The flip side of this conference is ‘not avoiding non-avoidable care’. By this I mean many die from preventable diseases in developing countries and many do not have access to basic necessities. As you all know NCDs are no longer limited to developed countries but they are also becoming prevalent in developing countries. How will they manage the triple burden of NCDs, lack of universal access to primary healthcare and lack of universal access to clean water and improved sanitation? It will require committed governments and good governance in health to reverse the trend.
Best wishes,
Enku Kebede-Francis, PhD, MS, MEd
Assistant Professor: Tufts University School of Medicine
Department of Public Health and Community Medicine
Adjunct Scientist:
Jean Mayer-USDA-Human Nutrition Research Center on Aging
136 Harrison Avenue
Boston, MA 02111
617 636-2714
617 636-4017 (Fax)
-----
(1) - From: Sandeep Saluja (doctorsaluja@gmail.com)
Thanks for the valuable and timely comments.
My feeling is that one of the problems lies in the way we think any patient should be treated. Textbooks of medicine lay down what appears to be ideal form of care and all medical students and experts feel that a certain protocol which is laid down in textbooks is the gold standard and then when one is asked to draw a protocol for resource limited area,one tries to do the same thing minus the expensive things. This is wrong!
One needs to appreciate that treatment protocols need to be redrawn for different circumstances. It is not that everyone should wear a three piece suit. Those who can not afford, can do still do the same minus the coat. Those who can not afford that can do minus the pant and so on. In fact, a traditional attire of say kurta and pyjama may be as good as a three piece suit. There is no gold standard.
-----
Original message - From: ProCor (procor@list.procor.org)
Dear subscribers of ProCor,
The Lown Foundation just concluded a major conference called "Avoiding Avoidable Care". This was an invitation only gathering of leaders in American medicine focused on the causes and cures for the large amount of unnecessary care that occurs in the US health care system. Keynote speeches were delivered by Harvey Fineberg, President of the Institute of Medicine, Donald Berwick, the founder of the Institute of Healthcare Improvement, (and until recently, the Administrator of the Medicare program), Dean Julio Frenk of the Harvard School of Public Health, Secretary of Health of the Commonwealth of Massachusetts Dr JudyAnn Bigby, and of course, Dr Bernard Lown.
There is clearly a growing movement towards defining and reducing the enormous amount of clinically ineffective waste in the US health care system, but judging from the comments we have been receiving and the coverage from the news media, we may have reached a significant tipping point. One can only hope so. The model of excessive, hi-tech care being adopted by the health care industry of low- and middle-income countries, and offered primarily to the emerging middle classes in the large cities represents a major opportunity cost for their societies. I know for a fact that in India, the private system of health care extracts significant amounts of wealth from people without giving equivalent value in exchange. This is an open secret outside the circles of polite conversation, but remains something that needs more attention.
I have maintained for years now that the huge amount of waste in the US and abroad represents a vast pool of resources that could be applied to extending coverage for other types of health care services, particularly preventive care and public health initiatives. The public health community and public health in general has been the victim of this misallocation of capital, and the perennial discussion about where to find scarce resources for prevention would have a different character if we were to take this issue into account.
Please visit www.avoidablecare.org to look at the details. We'll be making video of Dr Lown's speech available online when we have it. Dean Frenk's remarks, and those of many many others will also be published online over the next several days.
We welcome your reaction and comments.
Vikas Saini
President, Lown Foundation
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