Category Archives: Research

Give Boomer Esiason a break on birth comments

Retired football star and current radio host Boomer Esiason has opened the floodgates of righteous indignation by suggesting that the Mets second baseman should have encouraged his wife to have a scheduled C-section before opening day. That would have prevented him from missing the first two games of the season when he flew home to be with her.

Esiason got the blowback that he should have expected, and made a lengthy apology for his comments today.

I’m happy though, that this mis-step has turned into an opportunity to educate people about the dangers of early elective delivery. There’s actually been a major, successful effort underway to reduce the use of early elective deliveries. Such deliveries –either induced or scheduled C-sections before 39 weeks– represented 17 percent of births in 2010 (as high as 25 percent in some states). As of 2013 the rate has fallen dramatically, to less than five percent according to the New York Times.

It turns out babies born at 37 or 38 weeks have a lot more health problems then those born at 39 or 40  weeks, even though it doesn’t seem that such a short time difference should be so important. So I hope the reaction to Esiason helps to get this message across.

Esiason is getting the word out. Here’s what he said:

I’m very grateful to my many friends over at the March of Dimes who graciously reached out and re-educated me that if a pregnancy is healthy, it is medically beneficial to let the labor begin on its own rather than to schedule a C-section for convenience. In fact, babies born just a few weeks early have double the risk of death compared to babies born after 39 full weeks of pregnancy. As their promotional campaign says, ‘Healthy babies are worth the wait.’ And as a proud father, I couldn’t agree more.

I find it quite interesting how societal expectations about fatherhood have changed in the recent past. A generation ago, the notion of a father being in the delivery room was unheard of. Fifteen years ago I had a job interview with a large financial services company. The hiring manager (in his early 30s at the time) told me the job required an all out commitment, and that while he hoped to be present at the birth of his child, that wasn’t really the way things were prioritized there. I didn’t agree with that sentiment then, but it was the norm in many places.

So it’s interesting to me that Esiason took it for granted that the player would be present for the birth –he didn’t seem to question whether work should come first.

Esiason said the wrong thing, but I think we should cut him some slack. First of all, being a football quarterback is different from being a baseball second baseman. Baseball teams play 162 games per season, NFL teams only 16. A star quarterback plays every game, whereas even star baseball players get a day off from time to time. So maybe we can accuse Esiason of lack of empathy for thinking about how he would have behaved, not what a baseball player would do. But I understand his point about not wanting to miss a game.

Esiason is 52 and times have changed. He gets part of the new way of thinking –dad should be there for the birth. But he screwed up by suggesting unnecessary surgery. And while I don’t fault him for not knowing that earlier births aren’t good for babies, at least it gives people a chance to bring it up and make it known to a wider audience of would-be fathers who might otherwise not be paying attention.

By healthcare consultant David E. Williams of the Health Business Group


Back to the 1980s: My day at UC Berkeley

I was in the San Francisco Bay Area on business last week, and spent an interesting and enjoyable day on the University of California Berkeley campus, where I experienced two blasts from the past.

Choosing Wisely is the name of an initiative to prevent unnecessary use of medical tests and procedures. But it could also describe how I selected my 10th grade biology lab partner at Walt Whitman High School in Bethesda, MA in the early 1980s. At the time Mike Eisen was a smart guy who also happened to be the son of two scientists. He was a good  (and mischievous) student who knew a heck of a lot about fruit flies.

It will surprise no one from those days that Mike went on to become a prominent scientist himself with a lab at Berkeley. Speaking on behalf of my classmates, I will say we are also relieved that his mischievousness has been productively channeled into disrupting the scientific publishing industry for the public good as co-founder of the Public Library of Science (PLOS) rather than for the development of nuclear hand grenades or brain erasers, as seemed plausible back then.

In any case, Mike and I had a lot of fun catching up on work and life.

Later I had the pleasure of attending a graduate class taught by Veronica Miller, who is also the Executive Director of the Forum for Collaborative HIV Research, a long term client of ours. This groundbreaking class (US FDA, Drug Development, Science and Health Policy) in the UC Berkeley School of Public Health is all about drug development and the role of the FDA, using the examples of HIV and Hepatitis C.

There were two guest speakers: Romas Geleziunas, a scientist from Gilead who talked about what it will take to cure HIV, and a patient advocate, Matt Sharp, who was diagnosed in 1988 and has been on the leading edge of activism and research ever since. It was interesting to hear him discuss the early days of ACT UP with a group of students who are too young to remember what it was all about.

It made me think back to my 11th grade oral communications class with Mrs. Z in 1984. For our culminating project we had to give a speech on a topic we considered important and that others should know about. I had been reading about AIDS that year and was very concerned about the epidemic and how it could grow to affect the whole society. The conventional wisdom (passed down from the seniors) was it was best to do a speech about Mrs. Z’s cat, since that was the main thing that interested her. I decided to ignore that advice and did my speech on AIDS anyway, and spent a lot of time prepping it. When it came time to deliver my speech, Mrs. Z was chewing gum, filing her nails and looking out the window. I got a B, one of the few grades I remember from high school. (By the way, very few of my teachers were like Mrs. Z!)

On the one hand it seems like the last 30 years have flown by pretty quickly. On the other hand, the early 80s do feel pretty remote.

By healthcare consultant David E. Williams of the Health Business Group

How 23andMe got in trouble

Open sesame?

Open sesame?

Lukas Hartmann shares a great, detailed story (My deadly genetic disease was just a bug) of what happens when a self-described nerd is “confronted with a life threatening situation,” in this case a message about him from 23andMe that read:

“Has two mutations linked to limb-girdle muscular dystrophy. A person with two of these mutations typically has limb-girdle muscular dystrophy.”

Turns out this was the result of an error by 23andMe’s computer system. Now I’m all for patients having control over their lab results and getting away from the paternalistic idea that all results have to be filtered through a doctor. I support the new rule that gives patients direct access to their lab data. Still, this report on 23andMe is troubling and demonstrates what can go wrong when lab results are misinterpreted –either by patients, or, in this case, by a computer program.

Since I am stuck at the Cartoon Guide to Genetics level, I asked a scientist friend for his interpretation. Here’s what he told me:

The errors made by 23andMe are pretty basic:

1.  Lumping all forms of limb girdle muscular dystrophy into one entity and calling a biallelic mutation based on monoallelic mutations in two different diseases

2.  Even calling a compound heterozygote based on two different mutations in the same gene is sloppy because they could both be in the same copy of the gene, leaving the other copy functional.

Reporting such stuff directly to the patient when their output leaves much to be sorted out is a setup for false positives.  And using single nucleotide polymorphisms in the first place is less than reliable in diagnosing disease.  The results can be correct, but they can also be the genetic version of racial profiling.

23andMe is an expression of the approach that fancy software is more important than careful medicine.

There are definitely great opportunities to leverage knowledge and patient data to assist in diagnosis, treatment and clinical research. Companies like iCardiac, SimulConsult and Brain Resource are doing just that. But the technology has to be based on hard science and careful programming, and we still need expert physicians and scientists to interpret the results.

photo credit: widdowquinn via photopin cc

By David E. Williams of the Health Business Group.

More nursing shortage myth building

My piece on the nursing shortage myth received more than 100 comments when it was reposted on the Health Care Blog a year ago. My basic theme was as follows:

  • There’s a well-established narrative that there is a large and growing shortage of nurses
  • Evidence to the contrary –such as difficulty of new nursing graduates finding jobs– is dismissed by nursing shortage cheerleaders with two arguments: 1) experienced nurses come back into the workforce when there’s a recession, and 2) demand will explode over time as older nurses retire and baby boomers age
  • These arguments don’t hold much water and I am not particularly worried that the country will run short of nurses
  • Many of those predicting a looming nursing shortage have a vested interest in doing so because they are involved in the business of running nursing schools

It seems like I could re-write that blog post every year or so, because there always seems to be a new story acknowledging the current surplus of nurses but predicting a giant shortage in the future. I wrote a similar post a year earlier, for example.

Today I read another story about the so-called nursing shortage in HealthLeaders (New Nurses Report Tougher Job Market):

“The economic recession may be to blame for a downturn in demand for newly licensed registered nurses, suggests a survey from the Robert Wood Johnson Foundation. The lead author speculates, however, that demand will grow stronger as healthcare reform is implemented.”

The author –a professor of nursing– says the problem is the recession. Then she adds that older nurses are going to retire and the Affordable Care Act is going to boost opportunities. “The opportunities for nursing are going to be humongous,” she concludes.

As before, I have my doubts:

Workforce projections rarely take into account long-term technological change, but simply assume that nurses will be used as they are today. I’ve taken heat for writing that robots will replace a lot of nurse functions over time. People seem to be offended by that notion and have accused me of not having sufficient appreciation for the skills nurses bring.

So let me try a different tack. Think about some of the job categories where demand is being tempered by the availability of substitutes. Here are a few I have in mind that have similar levels of education to nurses:

  • Flight engineers. Remember when commercial jets, like the Boeing 727 used to fly with two pilots and a flight engineer? Those planes were replaced by 737s and 757s that use two member flight crews instead
  • Junior lawyers and paralegals. Legal discovery used to take up many billable hours for large cases. Now much of it is being automated
  • Actuaries. Insurance companies used to hire tons of them, but their work can be done much more efficiently with computers

I don’t hear visionary leaders of provider organizations banging the drum about a nursing shortage and clamoring for more grads. And if somehow I’m wrong and demand rises, the problem can be solved with a more welcoming immigration policy.

Like I wrote before, “If you want to be a nurse, go for it. But if you’re choosing nursing because you think it’s a path to guaranteed employment, think again.”


By David E. Williams of the Health Business Group

Despite botched ObamaCare rollout, public still trusts Democrats on health care


The AP is running a  story purporting to show a “potentially bigger problem for President Obama’s health care overhaul” than the botched launch of the federal insurance exchange: “Americans who already have coverage and aren’t looking for any more government help are blaming the law for their rising premiums and deductibles.”

The basis for the story is a new AP-commissioned poll, which shows that those who are experiencing rising premiums or deductibles associate those changes with the implementation of ObamaCare. The story goes on and on about the problems this represents for the President, even bringing in a noted Harvard professor to reinforce the point and piling on a few anecdotes for good measure.

But another reading of the results could lead to almost the opposite conclusion.

Why do I write that?

Respondents were asked, “Which party do you trust to do a better job of handling health care?”

Answer: 32 percent said Democrats and 22 percent Republicans. In other words, if everyone thinks that the rollout of the exchange has been terrible (which they do), and a high percentage of people associate rising premiums with ObamaCare, and have heard unrelenting criticism of ObamaCare from the GOP, how come these same people still place much higher trust in the Democrats? Maybe because the average person is a little more sophisticated than those who are looking for a sexy angle on a news story.

What’s going on? The answer is that it’s easier to follow the current narrative that ObamaCare is a big disaster than to engage in independent thinking. The poll is biased and so is the interpretation. Here are a couple examples:

  • The poll asks about changes in job-based insurance coverage, but almost all the changes are negative ones, e.g., is your premium rising, is your deductible increasing, is your plan being discontinued, is spousal coverage being restricted, are fewer types of medical care being covered? (Only one positive change is asked about: whether the plan is expanding to cover more types of medical care. And interestingly, more people (21%) answered yes to that question than the 18% who answered yes to the question about fewer types of care being covered.) If all the questions about plan changes are negative and people associate change with ObamaCare then of course it’s going to look like people are blaming ObamaCare for problems. If all the questions had been positive, (e.g., can adult children remain on my plan longer, is spousal coverage being increased, are preventive services being covered with no co-pay?) then the story would have to say people are crediting ObamaCare for the changes
  • A significant macro story is that medical inflation is decreasing. In facts, medical inflation was lower last year than it’s been in 50 years. Maybe the poll should have asked about the relationship of that with ObamaCare. That could have captured some the subtleties beyond just “is your premium rising?” Maybe the story should have highlighted the fact that 30 percent of people in the poll said their premiums were not increasing or made some comparison to prior years

Bottom line: sloppy and irresponsible reporting on the part of the AP.

photo credit: via photopin cc

By David E. Williams of the Health Business Group.

Avoidable emergency department visits: Lessons from the Robert Wood Johnson Foundation (transcript)

This is the transcript of my recent podcast interview with Susan Mende of the Robert Wood Johnson Foundation.

David E. Williams: This is David Williams from the Health Business Group. I’m speaking today with Susan Mende, senior program officer at the Robert Wood Johnson Foundation. Susan, thanks for joining me today.


Susan Mende: My pleasure.


Williams: Susan, let’s talk about avoidable emergency department visits. I know that the Foundation has been funding work on that topic. So, first question: how big of a problem is avoidable emergency department visits?


Mende: It’s a pretty big problem. It’s a problem for patients, for overcrowded emergency departments and for costs. We’re finding that there are increasing numbers of emergency department visits and that patients’ demand for the emergency department is increasing at the same time that the number of hospitals with emergency departments is decreasing.


We found a 20% rise in emergency department visits between 2000 and 2010, but at the same time we see an 8% decrease in the number of hospitals with operating emergency departments between 1991 and 2010. So, what happens is that we are seeing large numbers of patients in overcrowded emergency departments waiting longer and longer.


Williams: Why isn’t the solution just to build more emergency departments? You talk about avoidable visits, but is the goal to just avoid these visits? What does that mean?


Mende: We all want emergency departments to be there in real emergencies. Certainly, for you or me, for our families, we want to know that if we are facing something life-threatening or something that seems really, really scary or really, really acute, that we want to know that the emergency department is there.


The problem is we’re finding that 70% of emergency department visits are not true medical emergencies. If these patients had been able to get to effective primary care in the time that they need it, they could have avoided going to the emergency department.


If you go to the emergency department there is often a very long wait time and still all of your problems and complex medical issues or social issues that you’re facing might not get addressed. Because emergency departments are really, really busy places where the idea is to diagnose, treat and move on to the next patient.


So first of all, people are not getting comprehensive care there. It’s not getting coordinated. If they show up at the emergency department over and over again, they’re probably going to be seeing different providers. A lot of the information about what happens with patients in the emergency department doesn’t get transmitted to their primary care doctor, so the doctor might not know that a medication was changed, that a test was done. And vice versa, the emergency department doesn’t necessarily know what kind of medications the patients are on, their whole medical history or what kinds of tests or procedures were already done. So, we can have a lot of duplication.


So there’s a question of quality and a question of cost as well. When a patient receives care in the emergency department that’s not really emergency — that is unnecessary — we all pay the price. We found that in 2007, the average cost of a visit to the ED or Emergency Department was $767.  At the same time, if you went to an office-based visit, the cost is $187. That means a cost difference of $580. So the healthcare system could save about $38 billion if we can eliminate all the unnecessary emergency department visits.


Williams: Susan, I understand the foundation has been funding some efforts to do just that; to look for opportunities to reduce these avoidable visits. Can you describe the sort of projects that have been funded and what sort of results you’re seeing?


Mende: The Robert Wood Johnson Foundation has a program that called Aligning Forces For Quality or AF4Q. It’s our signature program. This 10-year initiative works to improve the quality of care in 16 communities – some of them small, some of them big – all across the country. The idea is that we work to improve the care and the quality of care in these communities and also develop models and resources for other communities to learn from and to follow. A number of these Aligning Forces For Quality communities have been involved for many years in targeted efforts to reduce inappropriate emergency department use.


Williams: Have you found that the same kind of best practices work in different places? I understand that the AF4Q communities are in diverse settings, some urban, some more rural and in different parts of the country with different characteristics. Is it the same sorts of things that work in different places or are there all different kinds of answers and responses?


Mende: What we’re finding is that some of the issues are the same across the country, such as people showing up in emergency departments for conditions that would be much better treated in the primary care setting. But what we’re finding is that each community comes up with a solution that works for its own local circumstances.


For instance, one of the communities we worked with is Detroit. The group there is called The Greater Detroit Area Health Council. In Detroit they worked with their primary care practices to reduce the number of unnecessary ED uses. They work through the Greater Detroit Area Health Council with the Blue Cross network of Michigan and through Oakland Southfield Physicians, which is an independent primary practice association.


They implemented straightforward, low-tech interventions to reduce visits. For example they provided practices with scripts to use. The scripts would give them advice on how to do after-hours telephone recording and to telephone triage to direct patients to the appropriate providers. As a result every practice didn’t have to develop these on their own.


We wanted to reduce the barriers of patients getting through to primary care and having to go to the emergency department. So they gave advice about scheduling policies that allowed for patients to come in to see the doctor the same day as well as scheduling to allow patients to come in evenings and weekends, which is when a lot of patients go to the ED because they can’t get in to their primary care provider at that time.


Also, they felt that it is really important to follow up with patients who recently visited the ED. They wanted to remind patients that they should schedule a follow-up appointment with their primary care doctors after the ED visit. And they also wanted to tell them, “Listen, we’re here beyond 9:00 to 5:00.” We want to tell them that there are after-hours and weekend availability.


And for every new patient who came in, they developed what they call a welcome letter. And that would lay out what the practice was offering, their office hours, their scheduling policies, their after-hours contact numbers and how patients could get a hold of them after hours.


They found that before they started these different interventions, they were seeing the rates of emergency department use increase for conditions that should really be better treated at the primary care office. They had a high of 49 visits per 1,000 patients affiliated with their Blue Care network members.


After they did these interventions –starting in 2010– they found quite a dramatic decrease. They recorded a decrease to 7.43 visits per 1,000. So that was from 49 to 7.3. They were very pleased with that success and those results.


Williams: Some of the demand for ED visits is based on patient preference. But some demand seems to be driven, at least in my own experience, from the provider side. In other words, patients may call the provider especially off-hours and the provider may suggest going to the emergency department. Do you find that to be a key factor or is my experience unusual?


Mende: I think that factor is present in a number of communities. And I think that some of the work that we just talked about in Detroit really addresses that. There is a responsibility on the part of the primary care providers to not only educate patients about what is an emergency, what’s really appropriate to go through the emergency department about, but also they have to do things to increase access to their practices – things like same day scheduling. Sometimes people go to the emergency department because they just could not get off from work. And by the time they get off of work, their primary care practices are closed. And so a number of primary care practices are extending their hours or staggering their hours, changing their hours, offering weekend hours. And so I think there’s really responsibility from the primary care practice point of view to educate and to make themselves accessible.


Williams: In addition to the best practices that you are putting forward, are there changes that are needed to reimbursement or other kinds of rules and incentives in order to enable this? Some of the things you’re describing, for example, that a primary care practice might do sound like the right thing to do, but may not contribute to the bottom line.


Mende: Yes. I think that these kinds of changes, for primary care practices, certainly do have some financial implications. There are a number of initiatives around that are trying to address this. There’s something called Patient Centered Medical Homes, where practices get paid a certain amount of money per member per month to increase their accessibility, to provide better care coordination, and to provide better patient education.


And that’s just one example of the kinds of payment reforms or different ways of paying practices to increase their access and improve the quality of their care.


Williams: Are there ways for people who are not in communities that have Aligning Forces for Quality alliances to get access to some of the resources that you’re making available, whether they’re patients or whether they’re providers?


Mende: Yes, absolutely. We’ve learned a great deal from our work with Aligning Forces for Quality communities over the past seven years, about what works and what doesn’t work to reduce ED overuse. And so we packaged these lessons into a series of materials that are straightforward, that people can use as a guide and that they can adapt in their own communities.


We have issue an brief that talks about the role of better coordination with primary care settings in reducing inappropriate ED use. We have a wide compendium of resources that provide links and additional information for providers and organizations. We have a series of three case studies, one of them which is from Detroit that I mentioned. We have case studies from New Mexico about some public service announcements and public education that they did around this issue. We have resources from Wisconsin. Really detailed information about how communities tackled this issue. We have a guide for primary care practices on working with their patients to reduce avoidable ED use and a webinar. We have interviews about simple steps that you can take. And all of these materials are available free for charge if you come to our website.


Williams: Susan, final question. As you mentioned, the level of emergency department visits had increased over the past decade. You’re certainly taking some steps here that are meaningful in order to reverse that trend, especially to reduce some of those avoidable visits. What is your overall level of optimism or pessimism about where this is headed? Are we going to look in another 10 years and see that the avoidable use of emergency department has continued to increase? Is it going to level off? Are we going to see potentially a dramatic reduction?


Mende: I’m very hopeful about tackling this problem. It’s certainly not going to happen overnight. It’s a very complex problem due to many of the factors that we’ve talked about. But I think that patients are feeling the pinch. Many of them have higher deductibles if they do have insurance cover. For some of them, the health plans are not paying or not paying the full cost of the visit if the health plan considers it a non-emergency. And patients are concerned because they don’t know how much it’s going to cost them if they walk in to the emergency room. They don’t know what the bill is going to be when they walk out and they certainly don’t know how long they’re going to have to wait. And they certainly don’t know whether or not they’re going to get the care that they need and care that’s coordinated with their primary care providers.


So I think that patients are feeling the pinch in many ways. I think there is a great deal of public service analysis, a lot of patient education around this issue and around getting alternatives that patients can take. I think a number of practices are taking very bold steps to educate their patients and to make themselves more accessible.


A number of hospitals and primary care providers are working together. For instance, a number of hospitals and healthcare systems have made agreements with primary care providers so that they share the data on which patients are coming to the emergency department and the practice can look through the data for their own patients, for their own panel of patients. They can see who came to the emergency department, they can follow up with them. They can identify patients who go to the emergency department over and over again and do a deep dive with these patients, find out why they’re going there, do they need to better coordinate their care; are there medical problems or social problems that are not being addressed?


So I think there were are many different ways that we are tackling this problem. And I think it’s gotten more and more attention as being both a quality problem and a cost problem. And so I am quite hopeful that we are going to make significant improvements.

By David E. Williams of the Health Business Group


When evaluating physician and nurse shortages, consider the source

‘Alarming’ Physician Shortages Lie Ahead, according to a HealthLeaders headline that’s bound to raise your blood pressure. Chances are you’ve seen even scarier articles about the looming nursing shortage, with predictions of a shortage of hundreds of thousands of nurses in the coming decades.

We do have serious doctor and nurse workforce issues in this country and we need to plan for the future, but before you get too worked up, it makes sense to consider the source of these pronouncements. The latest doctor shortage warning is brought to us by the Association of American Medical Colleges, a group whose objectives are to expand medical school enrollment and boost federal funding for residency programs. The original article appears in the current Health Affairs issue that’s devoted to “redesigning the health care workforce.” As I mentioned earlier this week (Talking sense about the physician workforce), the issue as a whole is a breath of fresh air in that it is largely free of the alarmist approach to the topic. My favorite articles Expanding Primary Care Capacity By Reducing Waste And Improving The Efficiency Of Care and Accelerating Physician Workforce Transformation Through Competitive Graduate Medical Education Funding demonstrate sound, innovative alternatives to simply jacking up the number of medical students. Maybe HealthLeaders should cover the full issue rather than just the extreme perspective.

As I’ve documented repeatedly, the nursing shortage is a myth. Nursing schools have boosted their enrollment and students have flocked to borrow money for tuition with the expectation of secure job prospects. And yet many new nurses can’t find jobs. Look closely and you’ll find that many of those that talk about a nursing shortage are the nursing schools that train nurses and not those who employ nurses –such as hospitals. In this case, proponents of the nursing shortage myth have harmed would-be nurses by misleading them about the job market.

So yes, let’s have a rational discourse about workforce needs and consider training more people when appropriate. But let’s not get too worked up by self-interested attempts to boost the medical and nursing school industries.

By David E. Williams of the Health Business Group.

Harnessing patient activation to reduce readmissions: Interview with Insignia

Hospitals are getting serious about reducing avoidable readmissions now that there are financial incentives to do so. Patients who score high on “patient activation” based on their knowledge, skill, and confidence are much less likely to be readmitted according to research by Judy Hibbard, a professor of health policy at the University of Oregon.

In this podcast interview, Chris Delaney, CEO of Insignia Health explains how his company has commercialized the Patient Activation Measure (PAM) to address the readmission issue.

By David E. Williams of the Health Business Group.

Clinical documentation –my guest post on For the Health of IT

Health care reform, technology changes and patient expectations are driving major shifts in clinical documentation. My guest post at For the Health of IT, a Nuance Communications, Inc. blog lays out key trends and describes ways that provider organizations can adapt.

There’s a link to the new Health Business Group study, Clinical Documentation Trends in the US, 2013-2016, which is available for free download.


Do veterans have timely access to mental health care?

A front page USA Today article declares Many veterans face frustrating delays for mental health care, and reports that the Department of Veterans Affairs “failed to meet its 14-day goal in 34% of new mental health appointments.” I agree that it’s a problem if veterans aren’t being accommodated in a timely fashion and am happy that statistics like this are being publicly reported because they increase accountability in the system.

But access to mental health services is a challenge in this country in general. Try to book an appointment as a new patient with a mental health professional and see how long it takes you. Which brings up my main point: government-run systems like the VA actually measure and report things like waiting times, while systematic statistics on access to care are unavailable for the general population. Tell me who’s responsible for making sure non-CA patients can get an appointment in any specialty within a specific time frame.

Interestingly, there is more accountability for access in socialist systems such as the UK’s National Health Service. On the UK government site you can download a spreadsheet of monthly statistics by specialty and region. Take a look here for the most recent data.

I don’t support a government run health care delivery system for the general population, but before we start blaming the VA for offering poor access or make a blanket statement about rationing and wait times overseas, it would be good to confront the facts and see what we can learn. I, for one, would like to see systematic statistics on access for commercial, Medicare and Medicaid patients. And we might as well compare these stats to the VA’s while we’re at it.

As a started I’d be willing to bet we can find plenty of places where access to services is slower than in the VA system.