In 2000, Troyen A. Brennan of Boston’s Brigham and Women’s Hospital published a commentary in the New England Journal of Medicine. In it, he said that the results from the two studies of medical care errors that were the basis of the IOM report were misused. He was one of the investigators who did them. In his words, “neither study cited by the IOM as the source of data on the incidence of injuries due to medical care involved judgments by the physicians reviewing medical records about whether the injuries were caused by errors. Indeed, there is no evidence that such judgments can be made reliably.” He also characterized the IOM recommendations as “giv[ing] the impression that doctors and hospitals are doing very little about the problem of injuries caused by medical care…yet the evidence suggests that safety has improved, not deteriorated.”

Another 2000 commentary by McDonald et al. in JAMA pointed out that the IOM figure of 98,000 deaths was extrapolated from the Harvard Medical Practice study. That study looked at 173 actual deaths in a 1984 hospital admissions database of 31,429 acutely ill patients. Though the study’s authors said only that adverse events may have contributed to the 173 deaths they identified, the IOM simply assumed that each individual died as the result of the errors and extrapolated the results to the entire population. McDonald also notes that the IOM also claimed support from another study that found medication errors caused 7,000 deaths in the United States in 1993. Fortunately, subsequent correspondence in the literature showed that this number was vastly overstated because deaths from drug abuse had been included in the medication error classification. A 2001 article by Hayward and Hofer revisited the topic, and found that the IOM wildly overstated error rates.

A 2004 article in the CMJ by Baker et al. compared errors for hopsital patients in the Anglosphere. The U.S. had considerably lower error rates. While the best error rate is zero, the IOM statistic is being used in policy discussions to paint the U.S. system as deficient compared with those in which government exercises more control.

I set up an account, funded in part by the government and in part by the individual, that can be spent only on health care, but in any way the individual wants. The only way that it can be spent other than on health care is to pass it on in the individual's estate when they die. I guess that's something.

Seems to me that there has to be some restriction, otherwise more people will end up on charity. I want to keep the number of people on charity to a minimum so that they will not have the political power to make the charity (aka safety net) too generous.

Cost control is key and only more true transparency at the medical service level (not plan), turning the “benefit” back into dollars for the consumer to purchase with and creation of functioning market will do. Perhaps we could accelerate the buy-in to markets, transparency and consumer driven if we defined “up front” what ARE the more legitimate public sector functions of health care (as I believe). The dichotomous views of “all govt/public” or “all market/private” can’t get us there practically or politically.

It’s entertaining but sad to watch battling generational ads – AHIP with seniors defending their Medicare Advantage plans versus kids who pitch for insurance coverage funded by the Robert Wood Johnson Foundation. August will be quite a month.