What's The Secret to Better U.S. Healthcare

An example of a national healthcare effort better than the U.S. is in the Central American country of Costa Rica. The New Yorker featured a long article about how that country used to handle its healthcare, how it changed and how its data illustrates it has a better health outcomes than we have in the U.S. 

My wife and I received our Ph. D.'s from the University of Missouri. A senior faculty member there recently started a new way to improve health in nursing homes. The result was healthier people and lower costs for both the nursing homes and for Medicare.

The doctor who wrote the New Yorker article about Costa Rica said the health-care system in the U.S. is an on-demand system. A health problem crops up and the doctor and staff deal with it. Preventive care is not central to the system. Both the Costa Rican and Missouri models rely of a much discussed but never quite implemented preventive care system. 

In the U.S. there is a public health discipline. It gathers data and makes recommendations. It does not send heath personnel into the field, for the most part, to see patients. That is done by another discipline, people trained in administering medical services, i.e., doctors and nurses. What the two innovations above do is combine these. The resulting organization has the mission to both collect and monitor data but also be responsible for caring for patients and generate good numbers. In practice, each subunit is assigned a population of patients and is responsible for maintaining its health. It both collects data on its assigned patients and looks for problems. Then it addresses them.

Both in Costa Rica and in Missouri nursing homes, it has been found that when the health of a group is monitored small problems are solved and larger ones avoided. For example, it was found that nursing home residents sometimes do not drink enough fluid. Dehydration is not noticeable to less trained nursing home staff. When it creeps up on a resident it often results in kidney infection which in turn requires an expensive hospital trip and stay. Patients are often frail and the disruption can have serious consequences.

In Costa Rica pregnant women and children are routinely monitored for problems. Teeth cleaning and attention are free to patients. Previously hospital patient numbers were growing. Lower numbers reduced the planned new hospitals. Low cost preventive treatments have saved a huge amount of money and longevity of lives now exceeds that of the U.S. 

I recall decades ago when the term "Health Maintenance Organizations (HMO)" were supposed to accomplish preventive care. Yet, health care costs have skyrocketed since then. The key to healthcare that is both superior and less expensive is available. I wish we could have it.