The voices of Urban Institute's researchers and staff
July 20, 2011

One Health Care Problem Information Can Help Cure

July 20, 2011

We’ve heard it before in the long debate about health reform: the US spends much, much more per person on medical services than any other country and doesn’t have consistently better health outcomes to show for it. This problem has no easy fix, and there’s a lot of disagreement about what should be done.  But one thing we all ought to be able to agree on is that medical care shouldn’t make people sicker.

Every year, healthcare-associated infections— that is, infections that people get while being treated for something else—kill more people than AIDs or breast cancer combined. Almost 100,000 people died from such infections last year. Many more people had their hospital stays extended. And the medical system spent some $8 billion treating them. This is money we ought to go after.

Most of these infections occur in hospitals. After all, hospitals are where sick people go, so there are a lot of opportunities to spread germs. Experience has shown how hard it can be to wipe out these infections. But experts believe about one third of them could be gotten rid of with reasonable effort.  The potential $2+ billion savings in medical care costs pales beside the expected reduction in death and suffering.

What would it take? Long Island Jewish Medical Center in New York achieved a rate of zero in its intensive care unit last year for one common type of infection.  Allegheny General Hospital in Pittsburgh and Barnes-Jewish Hospital in St. Louis made similar progress. So it is possible.

But such success requires revamping procedures and practices and changing professional culture. Most important, the whole medical team—physicians, nurses, and physician assistants—has to be constantly vigilant.  Everyone in the hospital has to agree that patient safety is paramount and that no one is above being reminded to wash his hands before approaching a patient.

And, if you are that patient, speak up if you see that your physician skipped that step. Hard as that might be, you could save yourself (and your doctor’s next patient) a lot of suffering.

So why are don’t we hear more about in-hospital infections? For starters, tragedies in large metropolitan areas aren’t rare. Washington, DC, has several general hospitals. Severe illness or death due to an acquired infection just doesn’t make the evening news here.  In a small town with one hospital, such news would quickly reach and stir the whole community.

How easy it is to get the information makes a difference. When Pennsylvania made reducing hospital infection rates a state priority, it started requiring hospitals to make their infection rates public. That gives Pennsylvania hospitals a big incentive to do better. Between 2008 and 2009, the state’s hospital infection rates fell by over 12 percent. And, importantly, rates continued to decline the next year. Other states should follow suit. Information is powerful!  (Want to know what your state is doing? See http://www.ncsl.org/default.aspx?tabid=14084.)

What is being done nationally? For one thing, Medicare no longer pays hospitals for treating avoidable infections. (It’s really hard to believe that this step wasn’t taken long ago.) Also, the health reform legislation that passed last year provides funds to help hospitals put proven infection- control procedures into practice.

Money to help hospitals do it right, no money if they get it wrong, and  greater public awareness through publishing infection rates—these three steps can make the market work better to improve this relatively small but still very important part of health care. Maybe these cost- and life-saving steps will be contagious.

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