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Death By Medicine - Outpatient Iatrogenesis

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http://www.garynull.com/documents/iatrogenic/deathbymedicine/DeathByMedicine6.ht\

m#HEALTH%20INSURANCE

 

 

Outpatient Iatrogenesis

 

Dr. Barbara Starfield in a 2000 JAMA paper presents us with well-documented

facts that are both shocking and unassailable.12

 

 

The U.S. ranks twelfth out of 13 countries in a total of 16 health indicators.

Japan, Sweden, and Canada were first, second, and third.

 

 

More than 40 million people have no health insurance.

 

 

20% to 30% of patients receive contraindicated care.

 

 

Dr. Starfield warns that one cause of medical mistakes is the overuse of

technology, which may create a " cascade effect " leading to more treatment. She

urges the use of ICD (International Classification of Diseases) codes which have

designations called: " Drugs, Medicinal, and Biological Substances Causing

Adverse Effects in Therapeutic Use " and " Complications of Surgical and Medical

Care " to help doctors quantify and recognize the magnitude of the medical error

problem. Starfield says that, at present, deaths actually due to medical error

are likely to be coded according to some other cause of death.

 

She concludes that against the backdrop of our abysmal health report card

compared to the rest of the Westernized countries, we should recognize that the

harmful effects of health care interventions account for a substantial

proportion of our excess deaths.

 

Starfield cites Weingart’s 2000 paper, “Epidemiology of Medical Error” on

outpatient iatrogenesis. And Weingart, in turn, cites Johnson and Bootman, who

asked pharmacists to estimate the probability of adverse outcomes occurring as a

result of outpatient drug treatment. Statistics showed that between 4% to 18% of

consecutive patients in outpatient settings suffer an iatrogenic event leading

to: 112

 

 

116 million extra physician visits

 

 

77 million extra prescriptions

 

 

17 million emergency department visits

 

 

8 million hospitalizations

 

 

3 million long-term admissions

 

 

199,000 additional deaths

 

 

$77 billion in extra costs

 

 

Unnecessary Surgeries

 

There are 12,000 deaths per year from unnecessary surgeries. However, results

from the few studies that have measured unnecessary surgery directly indicate

that for some highly controversial operations, the fraction that are unwarranted

could be as high as 30%.74

 

IT'S A GLOBAL ISSUE

 

A survey published in the Journal of Health Affairs pointed out that between 18%

and 28% of people who were recently ill had suffered from a medical or drug

error in the previous two years. The study surveyed 750 recently-ill adults in

five different countries. The breakdown by country showed 18% of those in

Britain, 25% in Canada, 23% in Australia, 23% in New Zealand, and the highest

number was in the U.S. at 28%.113

 

HEALTH INSURANCE

 

A recent finding by the Institute of Medicine is that the 41 million Americans

without health insurance have consistently worse clinical outcomes than those

that are insured, and are at increased risk for dying prematurely.114

 

Insurance Fraud

 

When doctors bill for services they do not render, advise unnecessary tests, or

screen everyone for a rare condition, they are committing insurance fraud. The

U.S. General Accounting Office (GAO) gave a 1998 figure of $12 billion dollars

lost to fraudulent or unnecessary claims, and reclaimed $480 million in

judgments in that year. In 2001, the Federal government won or negotiated more

than $1.7 billion in judgments, settlements, and administrative impositions in

healthcare fraud cases and proceedings.115

 

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© 2003 Gary Null & Associates, Inc. (GNA)

 

 

 

 

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