Americans are losing patience with our nation’s healthcare system. But the reverse is also true -- our healthcare system is literally losing “patients.” More than 1,000 Americans die every day from errors, accidents, and infections in hospitals. Many more suffer at the hands of procedures that never needed to be done in the first place.
Consider early elective deliveries, which perfectly embody the five biggest problems in our health system. These are births scheduled without a medical reason between 37 and 39 completed weeks of pregnancy.
Problem 1: Too Much Unnecessary Care
Overuse and unnecessary care account for anywhere from one-third to one-half of all healthcare costs. That’s equivalent to hundreds of billions of dollars, in addition to the half-trillion dollars per year that experts attribute to lost productivity and disability.
Early elective deliveries are unnecessary, according to the American College of Obstetricians and Gynecologists. Several other highly respected organizations like Childbirth Connection, the March of Dimes, and the Association of Women’s Health, Obstetric & Neonatal Nurses have said the same.
Nonetheless, until recently these deliveries have become much more common over the past 20 years.
Problem 2: Avoidable Harm to Patients
Early elective deliveries harm women and newborns. Babies born at 37-39 weeks’ gestation are at much higher risk of death. They are also at a far higher risk for harms like respiratory problems and admission to the neonatal intensive care unit.
Avoidable harm is a problem for patients of all ages. One in four Medicare beneficiaries admitted to a hospital suffers some form of harm during his or her stay.
Problem 3: Billions of Dollars are Being Wasted
A report by the Institute of Medicine Health suggests one-third or more of health costs is wasted. The cost of early elective deliveries was estimated in a study in the American Journal of Obstetrics and Gynecology to be nearly $1 billion per year.
Problem 4: Perverse Incentives in How We Pay for Care
Traditionally, health plans, Medicare, and Medicaid pay providers for whatever services they deliver, regardless of whether the service truly benefits the patient. That’s created an epidemic of perverse incentives.
Our payment system encourages early elective deliveries. They generate admissions to neonatal intensive care units, and NICUs are profit centers. Studies suggest that reducing the rate of these deliveries to a reasonable number could eliminate half a million NICU days. That would lower health costs.
States like South Carolina and Texas are trying to reverse the incentives, as are many employers. Unfortunately, they are not the norm.
Problem 5: Lack of Transparency
It’s far easier to find information about buying a new car than it is to figure out where to go for lifesaving health care.
Transparency galvanizes change like nothing else. After rising for decades, the rate of early elective deliveries began declining after my organization, The Leapfrog Group, started reporting how often hospitals performed the procedure in 2010. Last year, the rate of early elective deliveries was 4.6 percent -- down from 11.2 percent last year and 17 percent four years ago.
Consumers deserve to know these rates for every hospital delivering babies in the country.
A Dose of Optimism
Thanks to public reporting, a growing cadre of providers, policymakers and consumer advocates are uniting to end early elective deliveries. The Department of Health & Human Services declared the issue a top priority. Regional coalitions are vowing to do the same.
Businesses and consumers must work together address these five big problems in health care. They all have a direct impact on their financial -- and physical -- health.
Leah Binder is President and CEO of The Leapfrog Group (www.leapfroggroup.org), an organization that works to improve the safety, quality and affordability of healthcare for Americans.
Published: Aug. 28, 2014 - Volume 13 - Issue 20