From the Editor – Issue 73

Health care is big, expensive business, fundamentally transformed by technology, and filled with difficult moral and ethical choices. It is the theme for this issue of Ethix.

In the United States, health care costs represent about one-sixth of the gross national product. The U.S. spends significantly more per person on health care than any other nation in the world. Yet standard outcome measures (e.g., infant mortality, longevity, quality of life after 60) place the U.S. down about 20th in the world. A big challenge for health care as a business is the customer is generally not responsible for the costs. The most expensive areas of health care (e.g., emergency care, end-of-life care) come at the most emotionally charged periods of life. Compounding all of this, many people in the U.S. have no insurance, and hence no access to much of the health care system. It is true anyone can get emergency care, but in addition to its expense, it may be less effective because it bypasses the preventive parts of treatment. The recent health care legislation has been politically polarizing and played a major role in the last election. In summary, this is an important industry both undergoing and in need of major transformation.

Because of the size and complexity of the issues here, this issue will be larger than usual. We have identified three types of leaders and will feature three major Conversations on this broad subject. The first is with Dr. Robert Wachter, professor and associate chair of the Department of Medicine at University of California San Francisco. He is also chief of the Division of Hospital Medicine at the university. Modern Health rates him in the top 10 of most influential physician executives in the country, and the highest ranking academic on their list. We have posted the discussion in its entirety.

In several weeks, we will post our second Conversation — with Dr. Gary Kaplan, CEO of Virginia Mason Medical Center in Seattle. Virginia Mason Medical Center was named Top Hospital of the Decade at The Leapfrog Group’s 10th Anniversary Gala in Washington, D.C., December 2. Leapfrog is an independent rating group assessing hospitals around the country for both quality and cost of care. Kaplan has led the hospital’s step-by-step adaptation of the Toyota Production System, seeking to improve health care outcomes and patient experience while lowering costs.

In January, we will post a third Conversation, with Luke McGinness, CEO of Dupage County Healthcare system. A professional hospital administrator, McGinness has taken a hospital system on the verge of bankruptcy to one of the most respected regional hospitals in the nation.

These leaders, coming from very different backgrounds and perspectives, all weigh in on the subjects of health care costs and outcomes, challenges around end-of-life issues, use of specialized (and expensive) technology, and health care legislation.

Mark Neuenschwander, a health care consultant specializing in bedside bar coding, joined me in the first two Conversations and provided me with the introduction to Bob Wachter. A former pastor, Mark has himself contributed significantly to this field of health care safety. In December of 2010, the Institute for Safe Medication Practices honored him as the 10th recipient of the Lifetime Achievement Award at their annual meeting. He has contributed an essay in this issue.

This is not the first time we have addressed health care issues in Ethix. In issue 41, May 2004, we had conversations with Dave McIntyre, responsible for a military health insurance business, and Don Labourr, a former executive with HealthSouth. Labourr left the for-profit health care business to start his own clinic in physical therapy, and we will also post an update on his work in this issue.

In the past, we have reviewed some key books in this field: The Checklist Manifesto by Atul Gawande, and The Healing of America by T. R. Reid. Over the course of the two months of this health care issue, we will add some other book reviews on the subject. Another article that we would recommend, also by Gawande, was published in The New Yorker in June 2009. This article was influential in shaping the health care legislation in the U.S.

Al Erisman
Executive Editor