A Conversation about Health-Care Delivery

Even after health-insurance reform, the United States faces huge tasks ahead in improving the quality of health care, according to Drs. Donald Berwick and Howard Hiatt of Harvard University, who addressed more than 60 members and guests of Cambridge At Home on January seventh. In the third of a lecture series held in the Piper Auditorium of the Harvard Graduate School of Design, they described enormous gaps in medical outcomes and costs between the United States and some 20 other developed nations.

Among statistics they cited was a scandalous overuse of CAT scans in the United States. Over 60 million such tests are performed annually in a population of 300 million people, meaning that every year one in five Americans undergoes the procedure. In addition to the unnecessary costs, Dr Hiatt noted that each CAT scan delivers the equivalent in radiation of 400 chest x-rays.

Excessive use of specialized tests is not necessary and is not universal throughout the United States, they reported. A number of communities, such as Cedar Rapids, Iowa; Everett, WA; and Tallahassee, Florida keep Medicare costs significantly below average. Health agencies in Cedar Rapids cooperate to accomplish this by limiting the number of specialized services offered and the number of hospital beds available.

Several organizations study such communities to determine whether their success in containing medical costs while maintaining or surpassing the average national level of medical outcomes can be translated into a national program. Among them are the Institute for Healthcare Improvement, of which Dr. Berwick is the President and CEO, and the Dartmouth Institute for Health Policy and Clinical Practice. For more information, please refer to an Op-Ed piece in the New York Times on August 13, by Drs. Berwick, Atul Gawande, Elliott Fisher, and Mark McClellan (www.nytimes.com/2009/08/13/opinion/13gawande.html).