Great Expectations

The fact that USA Today is running a series this week on reforming the health care system places the issue high on the policy agenda facing the new Congress.

Conventional wisdom within the health industry is that costs will be driven down and quality of care boosted if only patients behave more responsibly by practicing prevention and getting screened properly at the right time.

However, it is not happening and cannot happen so long as patients are in the dark about what they are expected to do, not only in preventing illness but also when they are ill.

Doctors, labs and hospitals have clear expectations about what patients must do; sometimes so obvious no one thinks to mention them (“make an appointment, arrive on time and plan to stay until your appointment is over”).

Sometimes expectations have changed, but the person hasn’t gotten the message about the change (“always check about getting physician pre-authorization for procedures and tests”). And sometimes the expectations come about through default as a result of gaps in communication among doctors and hospitals (“obtain test results and send them to all relevant physicians”).

But the most critical element in the system – the public – has yet to be let in on what it must actually do in order to get good care.

Before we can reform the system, we will have to inform its consumers.

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