Posts Tagged ‘Dr Atul Gawande’

Healthcare Reform Needs to Model Itself on Agriculture

Monday, December 28th, 2009

U.S. agricultural strategies applied to healthcare reform legislation could help rein in costs.The current healthcare fight is very much like efforts in the early 20th-century efforts to make food affordable to the common people.  In an important article in The New Yorker, Boston-based surgeon Atul Gawande talks about a time when more than 40 percent of an American family’s income was dedicated to paying for food; farming was a labor-intensive enterprise that employed nearly half the workforce; yet bringing the nation’s bounty to the table was a costly process.  The agricultural crisis – which prevented resources from flowing to other economic sectors – led to the United States Department of Agriculture appointing extension agents to teach modern farming methods to increase food production.  The strategies adopted by these agricultural extension agencies succeeded in lowering food cost to eight percent of income because the government proceeded by trial and error, continually adjusting their policies to respond to results.  Gawande suggests that similar local grass-roots strategies applied to healthcare reform legislation could help rein in costs.

The Senate healthcare reform bill does many good things – establishes insurance exchanges, mandates and tax credits to assure that at least 94 percent of Americans will have coverage.  What the legislation does not address is crucial – it has no mechanism to control spiraling healthcare costs.  Consider that healthcare accounts for 18 percent of every dollar Americans earn.  Between 1999 and 2009, the average yearly premium for employer-sponsored family insurance coverage soared from $5,800 to $13,400.  Medicare beneficiary rose from $5,500 to $11,900.

Gawande notes that “Where we crave sweeping transformation, however, all the current bill offers is those pilot programs, a battery of small-scale experiments.  The strategy seems hopelessly inadequate to solve a problem of this magnitude.  And yet – here’s the interesting thing – history suggests otherwise.”

“Getting our medical communities, town by town, to improve care and control costs isn’t a task that we’ve asked government to take on before,” Gawande writes.  “But we have no choice.  At this point, we can’t afford any illusions:  the situation won’t fix itself, and there’s no piece of legislation that will have all the answers, either.  The task will require dedicated and talented people in government agencies and in communities who recognize that the country’s future depends on their sidestepping the ideological battles, encouraging local change, and following the results.  But if we’re willing to accept an arduous, messy and continuous process we can come to grips with a problem even of this immensity.  We’ve done it before.”

“Positive Deviants” Will Revitalize the Healthcare System

Tuesday, June 30th, 2009

The solution to America’s healthcare crisis might just lie in deviant thinking.  This is the message of Dr. Atul Gawande, this year’s commencement speaker at the University of Chicago’s Pritzker School of Medicine.  Gawande is a general and endocrine surgeon at Brigham and Women’s Hospital in Boston, an associate director of their Center for Surgery and Public Health, an associate professor at the Harvard School of Public Health and at Harvard Medical School.

050102_Gawande_Atul_3.jpgHis concept of positive deviants identifies those communities and physicians who discover innovative ways to reduce costs and improve care  to deliver better outcomes.

Gawande cites a nutritionist who spent his career attempting to reduce hunger in Vietnamese villages.  This man asked villagers to identify which families had the best-nourished children to determine a “positive deviance” from the norm.  The answer was that those children’s mothers did not act in accordance with accepted village wisdom had the best outcomes.  Rather, they fed their children even when they had diarrhea; fed them several small meals daily rather than one or two large ones; and fed their children foods that others considered low class but were nutritious such as sweet potato greens.

In the American healthcare system, the positive deviants resist the tendency to view patients primarily as revenue streams – but as human beings.  Rather, these physicians deliver high-value healthcare without focusing too strongly on their practices’ bottom lines; they neither over-treat nor under-treat their patients with extraneous but profitable tests and procedures.

To quote Gawande, “Look for those in your community who are making healthcare better, safer and less costly.  Pay attention to them.  Learn how they do it.  And join with them.”