The Five Best Things and Five Worst Things About Healthcare in 2009

The 5 Worst Things

1. H1N1 and the way it has been handled by various governmental agencies, from vaccine distribution and prioritization, to guidance on the use of N-95 respirators, to details about risk factors for patients.

Lott of the Southern California Hospital Association says: "The government's handling of the H1N1 swine flu tops my list of the worst things that happened in 2009. The management of information, the poor inter-governmental agency coordination, and the mismanagement of distribution of vaccine by federal, state, and local government agencies was like watching an episode of the Keystone Cops."

On the upside, numerous lessons can be gleaned from this experience to better prepare for future pandemics and disasters.

2. Disintegration of what could have been intelligent, informed conversation about controlling costs of end-of-life care—which is useless in prolonging quality of life—into a histrionic shouting matches about death panels, exacerbated by tea baggers and unreasonableness.

3. The inability of hospitals to check with a federal database to learn whether health providers they might hire have any poor disciplinary or behavioral track records. Some 100,000 health providers disciplined for abuse, fraud, and other kinds of harm may still be treating patients because a law requiring disclosure of their records to potential employers has gone unimplemented for 22 years, prohibiting hospitals from knowing about their practitioners' questionable backgrounds.

Hospitals, nursing homes, and other providers should have access to the federally run Healthcare Integrity and Protection Data Bank (HIPDB), but a bureaucratic blockage at the federal level has prevented access.

4. There remains a dearth of comparative effectiveness research so health consumers will know what they're getting for their money. And health providers will understand the true value of what they may be doing out of habit.

We said in the best things that patients are increasingly able to review quality measures for care providers. And that's still a good thing.

But Steven Spear, a senior fellow at the Institute for Healthcare Improvement and author of the book Chasing the Rabbit, believes that today, patients still don't really have informed choice, in large part because providers aren't truly motivated to publish meaningful results on outcomes.

They make decisions about their choice of providers based on, say, whether they have a coffee shop nearby, the color of the rooms or what a neighbor said. "The good news of this, however, is that we're starting to talk about it," Spear says.

Spear says that if he were a health provider, "I want to inform the public so they would choose me. If you run a provider organization, the best prescription is advertise your performance, compare it to your neighbor's and then, patients and payers will move in your direction."

5. Health literacy and lack of personal responsibility in one's health remain a problem in today's healthcare. That's the bad news. The flip side is that there is increasing discussion by health insurers and other payers about rewarding patients, perhaps with refunds of their copayments, or through lower premiums, to become more health literate and personally responsible, perhaps through better diet, better adherence to treatment programs or closer attention to their lifestyles. There's more emphasis than ever before that for a large percentage of patients, better disease management is well within their control.