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Sick In America: Americans' Views On Health Care


On this Memorial Day, it's MORNING EDITION, from NPR News. I'm David Greene, with Renee Montagne.

NPR News - along with the Robert Wood Johnson Foundation and the Harvard School of Public Health - recently surveyed 1,500 Americans to see how they feel about the cost and quality of health care. We featured stories all last week that reflected poll results like this: more than half of Americans believe there is a serious problem with the quality of care.

To better understand why Americans feel as they do about health care, Renee spoke to an expert who's not involved with this poll.


That's Dr. Elliott Fisher. He's director of the Center for Population Health at Dartmouth College. One issue the survey highlights is the lack of communication between doctors and their patients. It's a problem that Dr. Fisher sees all the time.

ELLIOTT FISHER: We have developed a system of deeply fragmented health care, where many physicians are not even talking to the other members of the team that is providing care for the patients. And physicians often also don't do a very good job of listening to patients.

MONTAGNE: Well, it seems as if there's plenty of ways to communicate these days. And if it's not happening, what would help improve communication?

FISHER: Well, I think there, you know, within some hospitals they have adopted new electronic health records that can help, if used wisely. But I think we need to help physicians learn the importance of practicing as a high-functioning team. You know, we do not think of health care as a team sport yet. We practice as individuals. We walk into the room. We talk to the patient. We go back out. We write our orders, and assume the nurse is going to translate those, and that the next physician will come along and read that order. That simply is not the case in most settings.

MONTAGNE: That really sounds like 1955. I mean...

FISHER: It is 1955. I mean, we are, you know, we - Americans - physicians are trained in a model that has us thinking we're managing problems one by one. The payment system fundamentally reinforces this. We're each paid for each face-to-face visit or for each test that we perform. So the payment system reinforces the fragmentation that patients are experiencing.

MONTAGNE: Now, we heard another story about a hospital that changed the way it treats patients. At Fauquier Hospital in Virginia, there is organic food, quieter hallways, there's softer lighting. And we heard from Don Berwick - who is former head of the federal Medicare program - about that approach.

DON BERWICK: The amenities are nice, of course, but what really counts in patient-centered care is that the more patients and families and their loved ones participate in their own care, really play an active role in the care itself, the better the care gets. Outcomes get better, costs fall and satisfaction increases.

MONTAGNE: What is the evidence that outcomes are better?

FISHER: When you have effective team-based care within hospitals that pays deep attention to how patients are doing, the mortality rates fall. Most of the illnesses that Americans experience now are chronic illnesses. They require the day-to-day attention by the patient, and usually with the support of their families, to manage their clinical problems.

When diabetics are supported by family members and other caregivers to take the medicines correctly, to exercise, to diet correctly, their outcomes improve dramatically. Hospitalization rates fall by 40 percent. Complications fall by 40 percent.

MONTAGNE: Our poll also found that nearly 70 percent of Americans want their doctors to talk more broadly about issues that might affect their long-term care. I mean, instead of just talking about this specific medical issue at that moment, one doctor we heard from, Larry Shore(ph), described why that's kind of hard to do.

DR. LARRY SHORE: Part of it is when you have that pressure to see three, four, maybe five patients an hour, you can't wait for the exposition of the patient's story - which is exactly what you should do, but you can't.

MONTAGNE: Yeah, it does sound like you need to really know everything about the patient to be able to really fully treat them.

FISHER: There are some wonderful new models. When you move away from our current piecework model and fee-for-service payment, where the physicians have to, you know, see five patients or six patients an hour as the insurance companies pinch pennies and lower prices, when you move to new models of care, many of the things that physicians are doing can be done electronically, by email or by telephone. That opens up a huge amount of time in the office for the physicians to spend more time with their patients.

MONTAGNE: Well, just finally, when you looked at the results of this poll, what stood out for you?

FISHER: The poll just highlights two things we know about health care: It costs much too much, much more than it needs to. And some people in the United States receive great care, but most don't. Experts all agree that we're wasting about 30 percent of U.S. health care spending on simple waste. It's wasted on fraud. It's wasted on overtreatment. It's wasted because we don't provide good care. And it's wasted because we have a fundamentally flawed payment system.

MONTAGNE: Dr. Fisher, thank you for joining us.

FISHER: Happy to join you.

MONTAGNE: That's Dr. Elliott Fisher, director of Dartmouth's Center for Population Health.

GREENE: And Renee's conversation with Dr. Fisher wraps up our series Sick in America, exploring how Americans feel about the cost and quality of health care. Transcript provided by NPR, Copyright NPR.