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    Ailing U.S. Medical System Fails Patients, Experts Say

    Healthcare Control Needed

    continued...

    Patients often have to fight their way through a maze of providers to get the kind of care they need, says Richardson, who points out that 70% of the care in the U.S. is now provided for long-term illnesses, even though the system focuses mainly on short-term, acute problems.

    Sen. Jim Jeffords, (R-Vt.), chairman of the government's Health and Education Committee, says he hoped to introduce patient safety legislation this spring, based on the IOM's first report. That sobering document led former President Clinton to undertake a $50 million national effort to reduce medical errors. Jeffords also stresses the idea of putting the nation's $20 billion investment in medical research to better use in terms of enhancing healthcare quality.

    In addition to fragmentation in healthcare, patients also must deal with a payment system that often seems to reward inefficiency. For example, one health organization caring for 13,000 diabetic patients identified changes that could have saved some $10 million. But they weren't implemented because healthier diabetics would mean less revenue for the HMO, says committee member Molly Joel Coye, MD, MPH, of the Institute for the Future, an independent, nonprofit research firm in California's Silicone Valley that specializes in forecasting alternative scenarios for the future.

    "We can't expect to see major progress in the future on quality if they lose money every time they improve care," Coye says.

    Coye also touts the money-saving benefits of developing computer links with physicians.

    "An increasing proportion of doctors are emailing with their patients, but as the doctors point out to you, they're not being paid for it," she says.

    The report stresses that care should first be safe and effective, but also timely and patient-centered. In order to accomplish those goals, the committee recommends investing $1 billion in an "innovation fund" over the next few years to develop needed improvements.

    Such improvements are "urgent, they're important, and we're saying they're achievable," Berwick says.

    A coalition of doctors' groups has issued statements supporting the IOM report.

    "[A]s good as our healthcare system is, more needs to be done to improve quality," says E. Ratcliffe Anderson, MD, executive vice president and CEO of the American Medical Association.

    "Many of the report's recommendations begin to chart a course to the future. But some caution is needed to ensure that we avoid duplication of effort," says Dick Davidson, president of the American Hospital Association.

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