It has become increasingly difficult to navigate the health care system. Especially if you are older and have multiple chronic illnesses. Specifically, it means that if you’re hospitalized, you have a good chance of being treated by a physician you’ve never met and undergoing questionable tests and treatments that might end up compromising your health. It also means that if you subsequently seek rehabilitation at a skilled nursing facility, you’ll encounter another medical team that doesn’t know you or understand your at-home circumstances.
In her new book, “Old & Sick in America: The Journey Through the Health Care System,” Dr. Muriel Gillick, a professor of population medicine at Harvard Medical School and director of the Program in Aging at Harvard Pilgrim Health Care Institute, delves deeply into these concerns and why they’re widespread.
Her answer: a complex set of forces is responsible. Some examples:
- Medical training doesn’t make geriatric expertise a priority.
- Care at bottom-line-oriented hospitals is driven by the availability of sophisticated technology.
- Drug companies and medical device manufacturers want to see their products adopted widely and offer incentives to ensure this happens.
- Medicare, the government’s influential health program for seniors, pays more for procedures than for the intensive counseling that older adults and caregivers need.
Dr. Gillick’s book is very thought provoking and worth reading. She imagines a patient-centered reform of the health care system with Medicare as the engine of change, a transformation that would be mediated through accountability, cost-effectiveness, and culture change. Hopefully, Congress is listening.
