The work of Jack Wennberg and the Dartmouth Atlas for Health Care shows
that utilization and consumption tends to expand to fill the available capacity of the health facilities.
What can our community do to ensure that capacity is held to a level that does not
exceed that which is necessary?
EVANS: The Dartmouth Atlas, which you can, when you get back to your offices, Google it, and you can pull up St. Vincent’s 86th Street or Methodist downtown or Riley and it will tell you the intensity of care at that hospital measured by how many resources are used ranked against every other hospital. Needless to say, the big hospitals are high on that intensity scale, the smaller hospitals are low. The downtown hospitals are very high because of the specialty and acute care given downtown.
So you can change the intensity of care by eliminating service lines. Or what I think we should do—and I think most of the panelists would agree—is emphasizing prevention and keeping people out of the critical care hospitals. Then the Dartmouth Atlas would change overnight. Overnight.
Don’t forget, insurance reform means young, healthy people pay more and older people who have high blood pressure or high lipids or something like that pay less. That’s the reform that has to occur. And that’s why our politicians keep running into stone walls. Because at the end of the day somebody has to pay more to either take care of the uninsured or to recognize the actuarial risk has to be paid by those that are less risky for those that are more risky.
DEFUR: Regardless of whatever form health care reform takes, it is going to involve getting cost out of the system. And I believe the best approach to that is, where is waste in our system, how do we get that waste out, how do we get that cost out, how do we make sure that we’re not overextending, that we’re not spending unnecessary resources in growing or expanding services that aren’t needed? That’s the accountability that we all [need to] have.
OBEIME: Look at the five of us sitting here; I think without politicians hanging over us, I think we will come up with a great idea. More importantly, I think that if something is going to happen, it will take each and every one of us in this room, it will take everyone acting reasonably to do that. Education is going to be what the drive has to be.
One of my biggest worries in the last few years as I’ve taken care of people at the end of life is the degree of fear Americans have of death. And that’s amazing to me considering that this is a pretty religious and spiritual nation. All of us know two things that are true and that will happen: We’re born and we’re going to die. Unfortunately, I see that we are taking a position that says, “If you are an American, because we have all this technology, you will not die.” And that really bothers me because when I have a 95-year-old man in my room or in the ICU, who the family members are talking about—“Well, we’re not ready for this, they can’t die, they can’t die.”—I’m thinking, “You say you are Christian, the Bible says ‘three score and ten,’ which I think is 70. He’s 95. He had 25 years extra.”•
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