Demand Better! Revive Our Broken Healthcare System

by MD Sanjaya Kumar, David Nash

Much of the healthcare debate is centered on cost – the cost direct patient care, insuring millions of uninsured people, defensive medicine to avert malpractice lawsuits and administrative costs that eat up a large chunk of every healthcare dollar. How can we spend more than $700 billion each year on medical care that fails to improve patients’ health and often harms them? There is no easy fix to these problems, of course. But there is the best place to focus on quality. This is a book about debunking healthcare myths through the lens of quality. Poor healthcare quality derives from uncertainty in clinical decision-making, from persistent unexplained variation in physician practice patterns, from still-inadequate accountability for quality and patient safety, from payment for piecework and from medical training curriculum that is decades behind the curve. Reclaiming quality by addressing each of these deficiencies will transform the economics of our healthcare system. This is not a utopian critique. It is based on a quality revolution that is already underway and is gradually transforming the way medical care is delivered in the US. This is a pivotal moment in American healthcare delivery, marked by tremendous innovation aimed at “busting” our counterproductive improving physician decision-making, building a better research base to compare the effectiveness of different treatments for the same medical condition, devising accountability mechanisms that work, piloting second-generation pay-for-performance models, paying greater attention to quality improvement in medical training curriculum and expanding access to quality care in non-traditional venues. Even the reader who thinks he or she knows all about some of the topics in this book will appreciate the manner in which Demand Better! integrates these topics into a cohesive appraisal of core problems and cutting-edge solutions that are of the greatest interest to them.

224 pages, Paperback

First published January 1, 2011

Reviews

[Ehuerte · Rating 5 out of 5]

Very good.

Great presentation of all that is "unwell" in our system of US healthcare.

Somewhat sensational in its voice but I think that is warranted & effective.

I (as a primary care doc) thought of too many comments to list while reading this book but most of them are defensive. Recurring "defensive" thoughts most often were about defensive medicine, time constraints and patient accountability. Certainly with the move toward comparative effectiveness research with teeth, PCMH and payment reforms associated I expect many of my "defensive" concerns would be addressed.

I think a void in this discussion (both in this excellent book & nationwide) is strategies to support the "frail" people that are ill equipped (to varying degrees) to be active effective arbiters in their own healthcare. These folks are disproportionately hospitalized & expensive to the system and I suspect proactive investments in their wellness would prove cost-effective.

Great book and I appreciate the authors and others like them who are so devoted to improving or nations healthcare quality, safety & sustainability

[Becker S · Rating 2 out of 5]

not gonna work fella