Thanks to the efforts of an inspiring physician, Jeffrey Brenner, the Compstat policing method of mapping crime by time and location has been applied to medicine. In Camden, NJ, where he practised, 1% of patients account for a third of the city’s medical costs. The reason for this is the people with the highest need actually receive the worst care.

Brenner made block-by-block maps of the city, colour coded with hospital costs and discovered that two tower blocks were making heavy use of hospitals. In six years, 900 people accounted for 4,000 hospital visits and $US200 million in medical bills. He came to believe that patients in emergency rooms and hospital beds were actually failures of the health system because they could have been treated before the problem reached this level. For example, a child with asthma may go to hospital three times a year with bad asthma attacks because she never uses her inhaler and eats poorly.

One firm had increased the amount their employees had to contribute to health insurance and found employee health costs still continued to rise. The reason was because early retirees with chronic conditions could not afford the extra payments and so missed out on prescriptions and doctor visits. Then they ended up in emergency care. The upshot is that the system does not deal well with patients who need it most. Emergency rooms are designed for car accidents, not for a patient with a chronic heart problem.

Denmark has reduced the number of its hospitals from 150 to 71 and expects to have less than 40 in five years. This is because it offers quality out-patient care, including paying doctors to offer email, out of hours consultation, and nurses for complex care. In America, CareMore, is one company doing just that for the elderly.

The founder of CareMore noticed that, thanks to so-called health-maintenance organizations (HMOs), lowering costs became more important than giving care. He realised it is better to fix a problem at step 1 for $10 than step 10 for $30 yet the American health system simply focused on repair, rather than prevention. He discovered one third of patients failed to attend doctors visits, mostly because they couldn’t get there. CareMore provides free transport. Non-compliance with drug taking is also a problem, so CareMore provides “talking pill boxes”. Finally, some of the problems with diabetes can be minimised early, such as mending wounds before they lead to amputation. CareMore set up a wound clinic.

These examples sound rational and sensible. It is hard to believe that the current system of medicine lumbers on, becoming more and more expensive, yet less able to serve its market. With the aging of societies, it is crucial that some of these ideas are adopted – and quickly.

Ref: The New Yorker (US), 24 January 2011, The hot spotters. A Gawande. www.newyorker.com
The Atlantic (US), November 2011, The quiet health-care revolution. A Slywotzky and T Main. www.theatlantic.com
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Search words: healthcare, crime maps, hospital, emergency, employee insurance, costs, chronic illness, Denmark, wireless scales, free transport, CareMore, health maintenance organizations (HMOs), managed care, non-compliance, QuickView.

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