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A “sick care” system

Yale Medicine Magazine, 2012 - Autumn


A physician argues that the United States lacks a vision for providing health care.

The United States makes a fundamental error in its management of health, argues Stephen C. Schimpff, M.D., ’67, HS ’69. The nation leads the world in spending for medical care but lags in quality because it lacks a health care system. Instead, he writes, the United States has a “sick care” system, one “that waits until we become ill before it kicks into action.”

In his new book, The Future of Health-Care Delivery, the former CEO of the University of Maryland Medical Center evaluates the American system of medical care, describes trends that will influence medicine in the coming decades, and explains why we spend so much. Then he suggests changes.

Schimpff observes that our system is more adept at responding to acute illnesses than in undertaking the multifaceted care required to treat chronic disease. But chronic disease now dominates, and patients find themselves “shuttled” among specialists who rarely talk to one another. Patients are given too many drugs, devices, and procedures, each of which carries risks—preventable errors kill 100,000 Americans each year.

Schimpff describes innovative systems in which specialists work in teams to prevent duplication. He suggests changing insurance policies so that patients pay for routine care and rely on insurance to cover catastrophic costs. President Obama’s Affordable Care Act, he argues, does little to change the way health care is delivered because it focuses on ways to finance care. Instead, writes Schimpff, “We first need to establish a vision for health care … and then figure out how to pay for it.”

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