Home » Blog
05/14/2012 Poverty and Health: A Connection We Can't Ignore
04/30/2012 Cardiac Care - A Case Study in Practice Variation
04/16/2012 One Courageous Woman
costs poverty aca variation cost use quality health policy research politics health reform policy health insurance acos hmos communication essential benefits reform coverage sgr congress drugs class long term care va employers e-prescribing emrs patient safety medicaid states medicare for-profit nonprofit block grant tanf welfare reform hospice end of life non-profit evidence-based care waste washtenaw county uninsured population health managed care cms access cancer end-of-life care individual mandate ryan proposal obesity pharmaceutical industry r & d comparative effectiveness research evidence based care quality improvement collaborative quality initiatives cqi pharmaceuticals regulations prematurity exchanges heath reform antibiotics overuse geographic variation medical appropriateness health websites imrt radiation therapy medical errors constitutionality courts translate health care economics rationing insurance regulation incentives cardiology pcmh health disparities election british health care system safety net fqhc guidelines radiology pain early childhood electronic medical records physician employment aco dartmouth atlas cover michigan health care coverage insurance preventive care public health

In 2010, when we published our study on healthcare variation in Michigan, we were able to show considerable geographic variation around the state of Michigan on a variety of procedures and services. We intentionally chose services where the research indicated either a tendency toward over-utilization (relative to evidence-based guidelines) or where the guidelines were unclear.

Many Americans have an almost visceral reaction against what is sometimes called "socialized medicine." Socialized medicine is often discussed in the context of the British Health Service – where the government is both the payer and the employer of those delivering care. But the irony is, we have a superb example of a very similar approach here in America: the U.S. Department of Veterans Affairs.
It is difficult to find an issue that is more politically contentious than health care; particularly the policy changes and programs that are needed to assure that Americans have access to needed care. The liberal position tends to see health care as a right, and seeks a strong centralized public role in assuring that all Americans have access to the same kinds of benefits and care. The conservative position sees fiscal and personal responsibility as the top priorities; tending to favor decentralized, private market solutions.

In the April issue of the journal Health Affairs, my colleagues and I descibe the success of a broad collaborative effort that has been in place in Michigan to improve quality of health care. The focus of the April Health Affairs is what has happened since the seminal work by the Institute of Medicine – Crossing the Quality Chasm – was published.
One year ago, the New York Times reported on a series of serious medical errors that had occurred during the administration of Intensity Modulated Radiation Therapy, or IMRT. IMRT is a relatively new technology that uses sophisticated equipment to deliver high doses of radiation to very specific areas of the body, while sparing normal tissue. When administered correctly, IMRT can reduce the toxic effects of radiation therapy and allow higher doses than traditional radiation therapy. However, when this highly targeted beam misses its target due to a medical error, the results can be catastrophic.

This week our Center is releasing a report on geographic variation in health care use in Michigan. Geographic variation in the use of health care services has been well described in the literature for more than 20 years now. Jack Wennberg pioneered this kind of systematic analysis at Dartmouth and has been reporting this data on an ongoing basis looking at the Medicare population. In 1997, Jack partnered with Blue Cross and Blue Shield of Michigan to do the same kind of analysis looking at a commercial, under 65 year old population. The report in Michigan got a lot of attention when it was released in 2000 – and sparked some interesting community dialogs including one in Grosse Pointe, Michigan about why their rates of use for ADHD drugs was so high (highest in the state).

There is an increasing consensus that many high tech radiology procedures are overused but no agreement on what to do about it.
When I first came to Michigan from Indiana a year ago, I knew I was coming to a special state for health care.