The Oregon Legislature is grappling with proposed health care transformation in this 2012 short session. Some legislators are so focused on “defensive medicine” that they are overlooking the whole goal of the health care system: patient health and safety.
A CATO Institute study shows that caps do not lower doctor’s insurance rates or prevent defensive medicine
The CATO Institute, a respected conservative/libertarian organization, published an analysis of an unbiased study that showed that limits on malpractice caps do not reduce either defensive medicine practices or the cost of malpractice insurance, but such caps do have a negative impact on patient safety because such caps remove an accountability mechanism.
The argument about “defensive medicine” is also dealt with by existing law, which prohibits such abuse of the medical system. A provider who orders testing with no therapeutic value commits insurance fraud, violates Oregon law, and ignores the first rule of medical ethics to do no harm. Also, doctors who order unnecessary tests put the patient at risk by subjecting the patient to unnecessary medical procedures.
Caps also failed to lower doctors’ insurance rates in other states that tried adding caps. The caps produced no noticeable effects on doctor liability insurance premiums—meaning that doctors continued to pay the same amount in premiums for less insurance coverage. The real beneficiaries of a cap like the one proposed in Oregon are not the doctors, but the insurance companies who can report higher profits and less risk to their bottom lines.
Real Solutions to a Real Problem
More than 98,000 Americans die every year from preventable medical errors. Imagine a 747 jet liner crashing every day, all year long, killing all on board—that’s about the numerical equivalent to those killed in the health system through errors. Because of that epidemic number, the main focus of healthcare transformation must be to improve patient safety, rather than to minimize accountability for substandard care.
Fortunately, some recent innovations have been able to achieve both aims: patient safety first, then cost reduction. For example, Legacy Emanuel recently participated in a national study where it implemented simple procedures and check lists for all hospital staff to follow. These check lists covered really simple things, like:
- wash your hands between each patient,
- make certain all medical equipment is accounted for before finishing a surgery, and
- confirm that the chart in your hand matches the patient you are treating.
According to the Oregonian’s report on the results, using such a checklist saved Legacy over $13 million in one year, cut down on medical errors, and significantly lowered patient infection and injury rates. Other hospitals should follow this simple standard.
Another example of innovation in Oregon is the Oregon Health Plan’s recent use of outreach workers to help patients get the care they need early to prevent an emergency and help them understand how to navigate the system. These workers spend time with heavy users of the emergency medical system to understand their limitations and the needs they have, which, if met, would reduce their need for emergency services. The program is only five months old at this point, but it is working to get the patients the care they need and to reduce costs and burdens on the system.
OHSU began a program called 5G in 2010 that allowed nurses more control over their work space and to question procedures. That program successfully reduced falls in the unit, cut waste, and improved care. “These small efficiencies will save 5G nurses more than 250 hours in the coming year—and 200 miles in steps not taken.” And that was just one hospital. The program also responds to one of the biggest causes of a medication error: interruption. Under the program, nurses have “sacred space” where colleagues don’t interrupt them.
A legislative proposal implementing such proven methods of containing costs and improving patient safety would keep the focus in the right place: patient care and safety.
Justice for all…who have private health insurance
The problem with the proposed law is that it essentially creates a two-tier justice system. The first tier is reserved for individuals with private insurance. The second tier is for patients on the Oregon Health Plan (OHP). The new legislation would strip OHP patients of a basic constitutional right to trial by jury and instead and would limit or cap how much OHP patients can sue for when they are injured due to negligent, substandard medical care. Keep in mind that in order to claim any damages at all, the patient must first prove to a jury that he or she received substandard, negligent medical care.
Thus, if you have the good fortune to have your own insurance, you would be able to hold a negligent care provider accountable for substandard or negligent care—just like holding a child who throws a baseball through a window accountable for the damage done to the window. That accountability is a basic right, guaranteed by the Constitution and the inviolate nature of a person’s sovereignty over their own body. However, if you are on OHP, the two-tier system of justice would limit your access to the same justice, regardless of how terrible the negligence, no matter how high your future medical costs, no matter your life situation. So much for equality before the law.
On a similar note, we must question whether Oregon really wants to allow the government to require a citizen to give up a constitutional right in order to receive state services. Remember, the constitution limits government, not the citizens’ rights.
Conclusion
Real reform of the problems plaguing our health system begin with placing the patient over the system, not protecting the system and insurance companies before the patient.
Photo Credit: http://morguefile.com/archive/display/42863
