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My Right Knee
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
I understand Dr. Sapers' skepticism, given how poorly designed health care is today. My vision, however, is hardly that of a “Wal-Mart.” It is of a health care system that seeks to address each individual patient on his or her own terms, so far as possible. I believe that dedicated clinicians indeed try to do that as a matter of personal mission, and I also believe that modern understandings of health care as a system (not “aping business models”) with open-minded, scientific redesigns, can go a long way toward that vision. For example, waiting times can be reduced dramatically with relatively simple changes in time-honored, but illogical, scheduling systems (1). Much safer care is within our reach, if only we will commit to new levels of reliability in our processes.
Dr. Fleming accurately notes the toxicity of current financing systems with respect to the changes we need for truly patient-centered, reliable care (2). I disagree, however, about the promise of making patients more “cost sensitive,” which usually means shifting costs to individuals. I find little evidence that that helps, and besides, illness and poverty are too closely correlated to make that ethical social policy (3). Indeed, nations with globally funded, often government-sponsored health care with universal access seem in important dimensions to outperform our system at far lower cost (4). “Total quality,” in my view, will be found sooner in a health care system with clear mandates, policy guidance, universality, flexible funding, and public accountability than in one relying on the invisible hand of a market to care for the sick.
Donald M. Berwick, MD, MPP
Institute for Healthcare Improvement; Cambridge, MA 02138
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Article and Author Information
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Potential Financial Conflicts of Interest: None disclosed.
