Part 2 of the project has begun: we're back in Middlebury! Just a quick update - we are working hard to reconcile spreadsheets with the waypoints for each family, update the unique ID's for all families, and reflect on the process so we can evaluate what we've done so far. I wanted to share a few articles that I've been reading over the last few days, focused on what the US can learn from developing countries' health systems, as we strive to reform our own. This topic resonated with me from the opening paragraph of the first article I opened:
"The young doctor had just returned from a month working in a country in Africa, familiar to the rest of us only through pictures of its impoverished population and news reports of recurring natural disasters and political upheavals. “You must feel exhausted but great,” a senior colleague commented. “You went in there and you really helped those people.” But my younger colleague felt neither exhausted nor relieved to be back home, she confided when the older doctor had left the room. She had cared for dozens of patients with abscesses and broken bones, tumors and arrow wounds, relying on nothing more than a single rickety X-ray machine, a handful of battered surgical instruments and the aid of one well-connected local nurse. “We could get so much done with so little over there,” she said. “It’s like we’re not doing something right over here.”
Although we weren't working in clinics, this really struck a chord with me. I've been gushing about GHI's programs to everyone that will listen - how much they accomplish, how comprehensive and thoughtful the program is, how inspiring and strong the staff are. I don't mean to (completely) glorify Rwanda -- there are persisten problems aplenty -- but it certainly seems serendipitous that all of these articles highlighting opportunities to learn from developing health systems are dominating my screen right now.
In the SSIR article, the authors write: "Poverty seeps into emergency rooms and inpatient wards and pervades the health system." OUR health system, here in the US. How is it that we spend more than any other country on health care, and yet we fail to address the root causes of poverty and emergency hospital visits? I've been focusing on bridging gaps and reading about innovation and creative solutions. I appreciate the suggestions in these articles, however: it's time to also embrace "reverse innovation."
What We Can Learn From Third-World Health Care, from The New York Times
"The successes of PACT and Health Leads are no secret. But what does remain mysterious as our health care system threatens to implode is why more of us haven’t done the same and rushed to apply the lessons learned and proved elsewhere. “We keep trying to reinvent the wheel,” Ms. Onie observed. “The humbling reality is that we are trying to recreate innovations that have been robustly developed in the developing world.” In other words, we have yet to deploy what could prove to be the most powerful weapon in the fight to contain costs and improve the quality of health care: our own humility."
Realigning Health with Care, from The Stanford Social Innovation Review
"The United States is poised for a primary health care transformation. The health care system is in crisis, driven chiefly by escalating costs, suboptimal health outcomes, scarce primary care resources, and rising poverty. At the same time, thanks to grassroots innovation—and, in some cases, US-based funding—a growing number of health providers around the globe have learned to deliver high quality health care at low cost. Now we need to align our resources in the United States to bring this knowledge fully to bear in saving dollars and lives. And the time is, indeed, now. The dual, market-driven imperatives to cut costs and improve outcomes—and the inevitable shift away from fee-for-service reimbursement to shared risk between payers and providers—create an unprecedented receptiveness to new approaches in care delivery. The United States has a window of opportunity to seize this fluidity in the sector to broaden the health care product, place, and provider and thereby expand access, improve outcomes, and cut costs. This approach demands, as Gawande says, that we innovate by properly executing the solutions we already have—and that the private, philanthropic, and public sectors invest in these evidence-based models of health care delivery."
What Can Mississippi's Health Care System Learn From Iran? from The New York Times
"The main issue in Iran back then was “disparities in health between its urban and rural populations,” he told me recently. “In the U.S., these disparities exist. The Iranian model eliminated the geographic disparities, so why couldn’t this same approach be used for racial and geographic disparities in the U.S.?”"