Quality

"No comprehensive nationwide system exists for patient safety..." (Leape & Berwick, JAMA 2005)

What?! There isn't a federal regulation on health care?! Of all things. We regulate so many other things, but the health of our nation isn't one of them? How can this be? And why hasn't it changed?

Usually, I think fairly highly of the way this country is organized, with all of the different states having a say in their state's laws, because it makes some sense - California is worlds apart from West Virginia or North Dakota, as is New York from Texas. But sometimes, I really question why something like regulating health care for the safety of patients would be left alone.

Quality, I think, shouldn't just focus on the errors of clinicians, but should also focus on the over- and under-use of medical care, because these are very serious problems facing our nation. Quality should follow a certain standard of best-practices as decided upon by the physicians and specialists of this country. No matter the geographic location, every American should be entitled to the same standard of care. Nosocomial infections are widely preventable, so there should be a reevaluation of hospital standards to prevent more of these. Chronic diseases are widely preventable, or at least manageable to a greater extent than they are, so success, and therefore quality of care should be measured by how well chronic diseases are cared for. Certain tests like lipid panels and blood chemistry panels can tell so much about the health of a patient, and yet the frequency with which some patients receive these tests is much lower than others - usually traceable to insurance status, and frequency of visits. My point is that "quality of care" encompasses so many different branches of health care, that unless there is a nationwide standard, how could we possibly make sure that health care is equal across and within state lines?

I think it is and always will be difficult to improve quality because within our current system, there isn't much flexibility in terms of time, money and effort to make sure that every patient gets absolutely everything they need, no more no less. That is why all these incremental changes haven't affected the big picture very much. Unless we have one giant widespread reform to health care, it probably won't change very much - and with that reform, let's please make sure there is some federal regulation on health care!