Harvard Pilgrim’s efforts to redirect patients to lower cost diagnostic tests (Boston Globe, December 20) can be a first step in having healthcare sourcing decisions made based on quality and cost. This depends on the insurer’s recommendations reflecting both quality of care and cost data.  On the other hand, merely rewarding providers who have negotiated [...]

There is a straightforward way  to think through the problem of managing complex, dynamic systems for high performance and the avoidance of realized risk.
For examples, healthcare professionals regularly assess risk in complex, dynamic systems by determining where vulnerability exists and acting in anticipation of failure, to preclude it, rather than in reaction to failure, when [...]

David Brooks overly alarms readers by declaring that a typical Medicare beneficiary contributes only $140,000 in exchange for $430,000 in benefits (”Where Wisdom Lives,” NY Times, June 6, 2011).  Ignoring that payments are made in over three to four decades and taken out over two decades grossly exaggerates the size of the disparity, so mis [...]

Paul Krugman creates an overly romanticized and particularly inaccurate strawman image of how healthcare is delivered to criticize proposals for reform in comparison (”Patients aren’t consumers,” NY Times, April 22, 2011).
Here’s what things look like in actual practice.
Our daughter broke her arm in a play ground tumble.  We picked an emergency department based on the [...]

Dear Friends and Colleagues,
[1]Patients suffer avoidable harm due to breakdowns in the delivery of care,
according to 1999’s report, [2]To Err is Human, by the Institute of Medicine.
[3]Patients continue to suffer avoidable harm due to breakdowns in the delivery
of care, according to a study reported in November’s [4]New England Journal of
Medicine, despite extensive application of tools [...]