On Tue, 2003-08-05 at 03:44, Christopher Feahr wrote: > Tim, > RE: "That might be an accurate description of the US healthcare system, > but thankfully the US system is restricted (more or less) to the US, > despite attempts to export it and despite attempts by misguided > politicians elsewhere to copy it....(snip)... Thus, although dreams of > regional or national EHRs seem far-fetched in the US, they are > achievable elsewhere, I think, and perhaps within a decade." > > I share your concerns about the US healthcare model, which differs > mainly in the area of payment.
I would say it differs mainly in funding. "Payment" implies a market and transactions, and many healthcare systems just don't operate like that. For example, the public hospital system (about 75% of all acute beds) here in NSW doesn't - they are block funded, not paid on a patient-by-patient basis. Attempts elsewhere to introduce an artifical market into a centraly-funded model eg "funder-provider split" have met with only partial success elsewhere. It is a mistake to assume that the only way to organise the delivery of healthcare is as a market in which services are bought and sold. > Allowing 6000 insurance companies to > become so firmly wedged between patients and providers was NOT a good > idea. The only possible benefit to patients and the common good is > risk-mitigation... something that the US govt. is in a MUCH better > position to do fairly, and something that commercial health plans have > not really given us anyway. In fact "risk mitigation by my rules" being > obviously better than shouldering the full risk, has become the chief > subscriber-retention strategy for many health plans. Some people even > choose to remain in jobs and careers they despise, in order to have SOME > health coverage. Here in Australia the conservative government has had to provide all sorts of absurd tax and financial incentives to induce people to take out private health insurance (which funds access to private hospitals and a few other fringe benefits), and still the take-up is poor (less than 30% with private insurance) - simply because people feel confident that the publicly-funded system will deliver adequate care when they need it (and they are correct). Cost-containment? Our health expenditure is about 8.3% of GDP - well below that of the US. Quality and effectiveness? Population health outcomes here are much bettrer than in teh US, and other quality measures of hospital care are as good or better. Australia is not unique in this respect - most developed countries do better than the US. > > But it took us 40+ years to get into this jam in the US and we cannot > expect to back out of it overnight. If there is anything inherently > "unfair" about the US situation (besides the government failing to > accept its role of chief risk-mitigator) it is the lack of > representation of provider needs in the general area of "information > management" and standards development. I believe that we could live > with the US payer-model if our govt. found a way to even out the $-risk > of health problems for all patients... assure that all Americans had > access to a reasonable level of care... and funded a mechanism for > discovering and publishing provider requirements in the form of at least > a national, if not global standard. Note that even private health insurance here is "community-rated", which means that the insurers are not allowed to charge different fees for different risks i.e. the well subsides the sick. They are allowed to exclude coverage for pre-existing conditions (which are still covered by the public system, of course). The relevance of all this is that the macro-level architecture community EHRs will be driven largely by the organisation of the healthcare ecosystem in which they will exist. Thus US EHRs will necessarily operate quite differently to Australian or UK EHRs. The components of the EHR, such as archetypes or terminologies, might be the same, but the way those components are used will be quite different. Tim C > > -Chris > > Christopher J. Feahr, O.D. > Optiserv Consulting (Vision Industry) > Office: (707) 579-4984 > Cell: (707) 529-2268 > http://Optiserv.com > http://VisionDataStandard.org > ----- Original Message ----- > From: "Tim Churches" <tchur at optushome.com.au> > To: "Thomas Clark" <tclark at hcsystems.com> > Cc: "Christopher Feahr" <chris at optiserv.com>; "Thomas Beale" > <thomas at deepthought.com.au>; <openehr-technical at openehr.org> > Sent: Sunday, August 03, 2003 1:59 PM > Subject: Re: certification and verification of OpenEHR > > > - > If you have any questions about using this list, > please send a message to d.lloyd at openehr.org -- Tim C PGP/GnuPG Key 1024D/EAF993D0 available from keyservers everywhere or at http://members.optushome.com.au/tchur/pubkey.asc Key fingerprint = 8C22 BF76 33BA B3B5 1D5B EB37 7891 46A9 EAF9 93D0 -------------- next part -------------- A non-text attachment was scrubbed... Name: signature.asc Type: application/pgp-signature Size: 189 bytes Desc: This is a digitally signed message part URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20030805/ddaadf37/attachment.asc>
