America's healthcare industry is in a shambles, reeling from medical mistakes, disgruntled employees, limited resources, high costs and low confidence. Nothing seems to be working right, and nobody seems to be happy.
At least that's the dismal image lingering like a nasty hangover after the entire industry was shellacked last week by a remarkable flurry of negative reports, surveys, studies and polls. What's more, many of the most scathing revelations came straight from an unlikely source: healthcare organizations themselves, which engaged in serious cases of critical self-analysis and catharsis.
The bad news came in torrents, one day after another, trumpeted in a series of similarly dire conclusions: Consumer faith in the U.S. healthcare industry is plummeting. Spending on prescription drugs is at an all-time high. Some 95% of physicians admit they've witnessed "serious" medical errors. Nurses are unhappy, burned out, overworked and mistake-prone. America's biggest, wealthiest corporations are far more preoccupied by the cost of medical care than improving its quality.
"We've been building toward this kind of a set of events for well over a year," said Richard Wade, the American Hospital Association's senior vice president of communications. "It's all been bubbling up, and it shows that the public is finally getting to see all the pressures that the healthcare infrastructure is under. Right now, I don't think anybody's happy."
A coincidental convergence
Indeed, the concentrated dose of bad news stretched from every corner of the $1.1 trillion-a-year healthcare industry that seems to be critically ill and failing fast.
But was it an accurate appraisal of the sorry state of the industry, a coincidental convergence of loosely related reports or gross exaggerations of special-interest groups angling for a sympathetic ear on Capitol Hill?
"The week's flood of bad news was coincidental, but I think it reflects a deeply troubled system," said John Iglehart, founding editor of the journal Health Affairs, which weighed in on the bad news with articles on substandard care and the growing disaffection of nurses. "From the perspective of almost any stakeholder you ask-whether it's patients, providers or purchasers-no one is satisfied with the current system."
Like many others, Ron Pollack, executive director of Washington-based Families USA, a consumer-advocacy group, pointed out that concerns such as nursing shortages and rising drug costs hardly will come as a surprise to most Americans. Yet last week's wave of blistering reports, he said, demonstrates a "consistency" in overall perceptions about the industry.
"I'm not sure the issues here all occurred in a certain span of time," Pollack said. "The reports of the issues all happened in a short period of time. And I think it's clearly a reflection of the different manifestations of problems that will all ultimately harm the consumer."
Paul Ginsburg, president of the Washington-based Center for Studying Health System Change, said the steady stream of negative reports reinforces the widely held perception of a health system in near disarray.
"(The series of negative reports) makes me think that it seems like a lot of other industries have made a lot of progress in serving their customers better," said Ginsburg, whose contribution to the bad news was in a report about problems at hospital emergency rooms. "Well, how come the healthcare industry seems to be getting worse?"
A bad situation
Among the most pessimistic reports last week was a study by Rand Corp., a Santa Monica, Calif.-based think tank that described America's healthcare system as "substandard" and determined that only about 60% of the chronically ill get the medical care they need. The report said medical errors are rife and that about one-fifth of the care given to individuals with chronic conditions is unnecessary and potentially harmful.
Elizabeth McGlynn, a co-author of the Rand report, said she hopes the flood of negative information last week will help direct much-needed public attention toward the embattled healthcare system.
"I think the situation is bad, and it's been bad for a while," said McGlynn, director of Rand's Center for Research on the Quality of Health Care. "I think it would be inappropriate to conclude that somehow things have taken a dramatic turn for the worse. It's more like (these news reports) are mounting evidence that summarizes research that has been going on for decades."
McGlynn was just one of many critics last week to take a swing at the healthcare system.
Just two days after McGlynn's study was published, Ginsburg's organization released a report warning that patients across the nation are increasingly at risk because of overloaded, understaffed emergency rooms. The growing number of uninsured in America-43 million at last count-is a major factor, the study said. So, too, is an 8% decrease from 1994 to 1999 in the number of emergency rooms.
On May 8, the Robert Wood Johnson Foundation held a press conference in the nation's capital to release a new survey that said four out of five providers believe "fundamental changes" are necessary in the healthcare system. The survey also determined that 58% of providers and administrators believe that healthcare in the U.S. is "not very good," and that about 95% of doctors have witnessed a serious medical mistake.
Other highlights-or lowlights-of a weeklong critique:
* More than 40% of U.S. nurses are unhappy with their jobs and the same percentage report "high burnout" from their stress-filled profession, according to a study released by the University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research. A related study released last week said about one-third of hospital nurses blamed understaffing for at least one weekly incident of missed or delayed medication. And still another study-this one by Future of the Health Care Labor Force in a Graying Society-warned of a "severe shortage" of healthcare workers in the coming years.
* Fortune 500 companies, America's biggest and best, devoted more energy to controlling costs than improving the quality of care for their employees from 1994 to 1999, according to a study conducted by the John Snow Research and Training Institute in Boston. The study, which also appeared in Health Affairs, said more companies are cutting their employees' premiums, with 13% fewer companies paying 90% or more of those costs.
* At the same time that many employees are being forced to absorb increased costs, spending for prescription drugs rose sharply in 2000 for the fifth straight year, said the National Institute for Health Care Management Research and Educational Foundation. Spending for outpatient prescription drugs rose nearly 19% from 1999 to 2000, increasing to about $132 billion.
* Meantime, the AHA and the American Medical Association, the industry's organizational giants, released reports or testimony within days of one another claiming that providers are becoming hard-pressed to offer necessary services in the wake of increased governmental regulations and the burden of massive amounts of paperwork (See story, p. 8).
* Nearly one-third of Americans think they pay too much for health insurance, and half of those who will be eligible for Medicare don't believe they'll be able to afford the healthcare they need, according to a national "Health Confidence" survey of 1,000 consumers conducted by Employee Benefit Research Institute, a Washington-based group. Ironically, one of the organizations that has helped providers improve patient satisfaction with their services, the Picker Institute, is going out of business (See story, p. 12).
A blessing in disguise
"Clearly, there exist some deficiencies in our healthcare system," acknowledged Richard Coorsh, spokesman for the Health Insurance Association of America, which represents about 300 companies, including both managed-care and traditional indemnity plans. "All these reports show a clear link between lack of coverage and overall health."
"The good news," Coorsh added, "is that this will help increase public awareness."
Wade, the AHA spokesman, said the gloomy picture that emerged last week may be a blessing when the healthcare industry goes hat-in-hand to Congress, pleading for a third consecutive year of Medicare and Medicaid payment relief from the Balanced Budget Act of 1997.
Though no specific figures were cited, the report on nursing shortages called for increased wages, benefits, training and incentives-a cost that would almost certainly be underwritten in large part by the government. McGlynn's report for Rand was more specific. It called for the Agency for Healthcare Research and Quality to spend "a few billion dollars of new money each year" on efforts such as improved information systems, strategic plans and quality improvement. Of course, almost any ambitious plan will cost money-lots of it, mostly from the federal treasury.
Wade shrugged off the notion that all this bad news might be a slight exaggeration. "The cold, hard fact remains that you have one-third of the hospitals in this country on their knees financially," he said. "The more we talk about these problems in public, the more they'll serve as a catalyst for improvement."