The U.S. health care system is a mess by any measure. Costs are far higher than anywhere else in the world, but life expectancy and infant mortality rates are worse on average than in other developed countries. To add insult to injury, customer service is often abysmal.
It doesn't have to be this way.
Other sectors of the U.S. service economy -- such as retail, financial services and lodging -- are the envy of the world. Companies like Vanguard, Target and Hampton Inns offer higher-quality services, better customer care and lower prices than you'll find in other countries.
The U.S. health care system could be like that too, but the archaic culture of medical providers, distortion of the market by the third-party payment system, and the resistance to making tough decisions about medical costs and benefits complicate reform.
The best hope for reforming U.S. health care lies in information. We need to generate more and better information, make better use of the information we have, and be willing to apply information to make tough choices.
The good news is that it is starting to happen.
The kind of information we take for granted in other sectors is unavailable in health care:
How good is your doctor, really?
Which specialist is best for your condition?
Is that academic medical center with the great reputation better than the community hospital down the street?
How likely are you to die from a medical error?
How much does an operation cost at one hospital compared with another?
Does that drug you were prescribed work?
What were the other options for treatment?
How much does the drug really cost (not just the co-pay)?
Is the drug any better than a generic?
How does your genetic makeup affect the treatment you should get?
We're beginning to answer these questions. Consortia like Massachusetts Health Quality Partners and Integrated Healthcare Association, and private companies such as HealthGrades, offer information on quality and patient experience. (They still can't quite say "customer satisfaction.")
Medicare's Hospital Compare Web site has information about key quality indicators. Various "transparency" initiatives are under way to provide information on costs. Consumer Reports, rating drugs and Wal-Mart, shows just how inexpensive generics can be. Genetic profiling is further off, but groups like the Brain Resource Co. are starting to make personalized medicine a reality.
But it's not enough to make information available. We have to become better users of information and better communicators. We should also analyze and act on data that are currently ignored.
Empowered consumers have taken the lead: doing research on the Internet, establishing personal health records, demanding a greater role in their care, even negotiating prices. Now we need medical professionals to step up.
Many physicians are lousy communicators. Doctors are hardworking and dedicated but generally don't use e-mail and don't keep records electronically. They rely on treatments they're comfortable with rather than using evidence-based medicine, and are insufficiently skeptical of information from biased sources, such as drug reps.
Physicians rarely explain alternative treatments; many do a poor job of communicating diagnoses, laboratory findings and information about drugs.