Quality Progress - American Society for Quality

services, I am sure the cost of your car insurance would be as much as health insurance -
latest average around $5,500 per employee. How many cars could you afford to insure
with insurance rates like that? The double digit rise in the cost of medicine is driving
more and more employers out of providing health insurance to employees or making
them take a more significant share of the cost. To make health insurance affordable,
(which has a mutiplicicty of causes) one way is to take some of the routine meidcal costs
out and place them back on the individual. You can not have Lexus coverage at Neon
prices. I like my car and I like my life - I am the one who should be responsible for the
preventive maintanence of both. I agree there are those who have less resources and that
is where govenment should have a way on allowing them to access affordable preventive
care -- but that is a political problem which I am not going to get into on this listserve.
Even when government does that, and even now for those of us with "good" insurance,
when preventive care is affordable, it isn't done by every individual for two reasons - lack
of personal individual responsibility to have it done and lack of follow-up by physicians
to remind individuals to have it done. You know, when I take my dog to the vet, on the
receipt I get when I leave is listed all the preventive things my dog should have and when
they are next due. The last time you visited your Primary Care Physician, did your
receipt list your preventive procedures and when they were due? Prevention is worth a
pound of cure, but the QMS in human medicine doesn't push it. I know of an Internal
Medicince who took pride in the way he cared for his diabetic patients as this was an area
of special interest for him. He thought he had his diabetic patients well controled and was
going to show his colleagues. He did a study of his diabetic patient records to determine
what their A1C levels (blood test to tell how well controled one's diabetes is over a
period of time). To his suprise, his patients were no where near controlled as he had
expected. As a result of this surprising finding, he then taught his patients how to use run
charts with desired UL and LL and how to use them to get their blood sugars in control.
He had a significant impact on getting his patients where he wanted and finally got them
to where he originally thought he had them. Medicine could use quality tools not only
within the management of medical organziational business and implementing evidenced
based medicine, but also as a tool for helping patients help themselves to prevent diabetic
complications. Yes, Wes, prevention is good if it is used. Quality can have a significant
role in that. But, in the end, if the diabetic patient doesn't use the run chart his doctor
provides him, no one can make him. He wil end up with blindness and micro-circulation
problems which will lead to amputations of feet and/or legs. As a quality professional, I
would like to see medical care become more consistent, managed (by the provider not the
govenment or accreditatoin agencies), effective, and definitely more efficient. Gee,
sounds like what IWA-1 is supposed to help happen! Maybe we ought to be pushing
IWA-1 and excellence to our individual Primary Care Doctors when we see them. BTW,
Wes, until WW II, health insurance was as Walmart has it now -- only for covered
catastrophic events and then only by a few employers. The use of health insurance as a
benefit changed because wages were frozen during the war and the only way an employer
could entice the scarce labor force to work for them was to offer benefits not frozen by
Congress. This is where health insurance became a general benefit and the benefit has
been increasing ever since. HMO's started with Kaiser Permanente during the war too but
HMO's really didn't catch on until employers trying to implement cost containment had
Congress enact the HMO legislation in the early 1980s.