News de jour.	San Fransicso Chronicle National Section
October 21, 1997	US Health Care Can Kill, Study Says
	Doctors incapable, costs spiraling

Reuters

Washington

America's health care system is in a worse crisis than ever before, with costs escalating and patients dying because many doctors do not know what they are doing, the National Coalition on Health Care said yesterday.

More and more people are going without insurance and no one is keeping tabs on the quality of health care, the coalition said in a report grouping several studies that it commissioned.

"Our country's health care system,which was described as in crisis in the early 1990s, has not improved but actually become worse, " said Henry Simons, presient of the coalition.

The coalition, which includes 100 organizations ranging from the American College of Physicians to companies such as Bethlehem Steel Corp., unions, insurance companies and religious groups, said urgent action is needed to remedy the situation.

"In the absence of effective oversight, the marketplace is not taking care of the problems," said Robert Ray, co-chair of the coalition. "Our health care system needs major systemic changes if this country is going to provide high-quality, cost-effective health care to all Americans."

A Rand study commissioned by the coalition has found that millions of Americans have been injured and tens of thousands have died because of significant misuse, overuse and underuse of health services.

"There are distressingly high error rates reported in a wide range of medical practices with serious, sometimes fatal consequences," a summary of the study said. For example, autopsy studies show high rates (35-40%) of missed diagnoses, often resulting in death."

It cites a separate Harvard University study that estimates 180,000 people die each year because of medically induced injury or negligence.

The Rand report has found that what it calls "major gaps" in knowledge are contributing to medical uncertainty. "The evidence to justify treatment of even the most common medical and surgical conditions is often questionable," it said.

"This includes such common conditions as prostate cancer and low back pain, which affect millions of people."

There were large variations in care from region to region, but no evidence showing that people who have better access to hospitals and doctors fare any better, it said.

Doctors disagree on what treatment is best, with conflicting studies being published in medical journals. "Often, no one knows who is right," the coalition said.

There often are no standards for care, and even when there are, the standards are not followed, it said.

"There is no credible national database on quality, or a national technology assessment or standard-setting mechanism," it said.

A coalition-commissioned study by Kenneth Thorpe, director of Tulane University's Institute for Health Services Research, found that health care costs are increasing at twice the rate of inflation.

"In 1987, we were spending just less than $500 billion a year on health care. In 1994, at the height of the national health care reform debate, we spent $937 billion, a 5.1 percent increase over the previous year," it said.

In 1997, that number is expected to reach 1.1 trillion, an increase of 6.3 percent over 1996."

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