INSIDE STORY

Preventable deaths: the real healthcare threat

In the midst of a fierce, multi-year political battle over the Affordable Care Act (ACA, aka Obamacare) that led to a partial government shutdown in October, the casual observer might think that mandated health insurance coverage and computer start-up glitches that choked the government-run insurance marketplace websites represent the biggest threats to Americans’ collective health since the introduction of the cigarette.

We can certainly argue the pros and cons of the ACA (why let politicians have all the fun?), but I think most reasonable people – especially the analytically inclined – agree that spiraling costs have rendered the pre-ACA healthcare system inefficient, too costly and unsustainable. Certainly that’s what I heard last year when I interviewed half a dozen healthcare professionals who were turning to operations research and analytics to make their own hospitals and healthcare networks more efficient (“Analytics, O.R. & the future of healthcare,” Horner, Basu [1]).

Along those same lines, INFORMS Healthcare 2013, a conference held in Chicago a few months ago, brought together a “diverse group of researchers and stakeholders [that] shared information and insights that can improve the long-terms efficiency, effectiveness and quality of healthcare delivery.”  The range of healthcare problems and proposed analytical solutions was impressive, and by any measure, the conference was a huge success.

As I noted in the article (as well as a recent posting for Analytics), a combination of misaligned or conflicted incentives involving doctors, hospitals, big pharma, insurers, lawyers, politicians and patients results in resistance to change, overtreatment and defensive medicine, excessive administration costs, and unnecessary tests, medication and trips to the emergency room, all of which contribute to the U.S. healthcare system’s soaring costs while thwarting efficiencies. According to the Institute of Medicine, the U.S. health system wastes more than $750 billion a year – or 30 percent of medical expenses – in unnecessary, inefficient services, and each year tens of thousands of deaths could be averted through better care.

It’s that last point that authors Brent James and Doug Samuelson explore in more depth in this month’s cover story. According to a 13-year-old study by the Institute of Medicine (IOM), preventable deaths in the U.S. healthcare system total about 100,000 per year. However, James and Samuelson note that “recent analyses indicate that the IOM most likely understated the case. Preventable deaths within the medical system may be twice what IOM estimated, and the total number of adverse events – fatal and non-fatal – appears to have been underestimated by as much as an order of magnitude.” Based on the recent research, the authors peg the number of preventable deaths per year at around 200,000.

Which brings up a troubling question: If an estimated 200,000 Americans are needlessly dying each year and perhaps 10 times as many are injured as a result of system failures in medical care, why aren’t politicians on both sides of the aisle spending more of their time and energy investigating that relatively hidden but certainly very real threat to the collective health of Americans and looking for ways to solve or at least mitigate the problem?

The O.R. and analytics community is willing, ready and able to help.

Reference

1. Peter Horner and Atanu Basu, 2012, “Analytics, O.R. & the future of healthcare,” OR/MS Today, Vol. 39, No. 6. Available online at:
https://www.informs.org/ORMS-Today/Public-Articles/December-Volume-39-Number-6/Analytics-O.R.-the-future-of-healthcare

— Peter Horner, editorpeter.horner@mail.informs.org