Intractable health care crisis

How many times do we see some version of this statement or hear it on the news? But frequently it is embedded in a story about an innovative (and often privately funded and small) program modelled on a good business plan.

This week the WSJ featured a story about a program in Cincinnati to reverse its terrible infant mortality rates--one of the highest in the nation. But "Every Child Succeeds" program, started by Procter and Gamble people using a strong business model, has reduced infant deaths from 13 per 1,000 to 2.8 per 1,000.

"Preliminary findings demonstrate that ECS has been extremely effective. Ninety-eight percent of mothers in the ECS program have a medical home. 93% of ECS infants function at developmentally normal levels. Of mothers with smoking histories, 79% quit or drastically reduce tobacco use during pregnancy. Of the 29% of mother who enter ECS with clinically significant levels of depression, half are no longer depressed after nine months in the program. Observational data suggest that the ECS injury prevention component significantly reduces hazards to the child. Over 97% of mothers state that they are satisfied with the service received. ECS prenatal referrals have increased from 40% when the program began to almost 60% at the present time. An infant mortality rate for ECS families of 2.8 per 1,000 births, less than one-third of the Hamilton County infant mortality rate." (from ECS website)

Even with the incredible success of a program that flies in the face of the usual government procedures and has saved babies' lives, the writer includes snarky remarks like "in recent years as Washington as lost its taste for expensive and large scale poverty programs boutique projects have sprung up to help fill the void reducing their dependence on a state that's increasingly unwilling to shoulder the burden." Apparently the "culture" of slowness in the cooperating agencies and their reluctance to gather data, caused some problems even in a successful small program like ECS.

So on the one hand, we've got large scale, inefficient, unsuccessful programs with lofty goals to eliminate poverty which result in dead babies, but it's such a shame that the funding isn't increasing?

Then yesterday WSJ reported on a program to reduce ER visits by the poor by using in-home visits by nurses, and how a small struggling Harlem hospital has increased its income and reduced government pay-outs both by collaborating with Mount Sinai to gain access to specialties its patients needed. This keeps the hospital in a neighborhood that needs it, and serves the people better.

Intractable my foot.