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Medical Errors Make Health Care More Expensive and Decrease Access

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Richard T. Moore
July 15, 2019

Health policy will likely play a significant role in the 2020 election, according to a report from the Commonwealth Fund. Certainly access to affordable health care, especially the cost of prescription drugs, is an issue on the minds of American voters as they consider their choices for the White House and Congress over the next year and a half. Of course, most people assume that the health care they want will be delivered safely. Whether it’s in some form of Medicare for All, an expansion of Medicaid, an improvement of Obamacare or repeal and replace, any plans for expanding access to affordable health care must do better. We must not maintain the current rate of medical errors, which rank as the third leading cause of death in the United States.

Later this year, we will observe the 20th anniversary of the Institute of Medicine report, “To Err is Human: Building a Safer Health System.” The report estimated that as many as 98,000 deaths were occurring annually in acute care hospitals from mistakes in the delivery of health care. While the report focused on deaths in hospitals, no comprehensive statistics were available, and are still not available after two decades for adverse events in doctor’s offices, clinics or long-term care facilities. Despite extensive media coverage at the time, as well as Congressional hearings, other informational activities and even some progress in patient safety, the problem of medical errors continues. Medical errors are, in fact, one of the factors that accounts for the high cost of healthcare in the United States.

A new report from the Betsy Lehman Center for Patient Safety in Massachusetts, arguably among the top states in reforming health care and improving patient safety, identified almost 62,000 preventable harm events that resulted in over $617 million in excess health care insurance claims. The report, entitled, “The Financial and Human Cost of Medical Error and how Massachusetts can lead the way on patient safety,” found that, “In the aftermath (of medical errors), many suffer long-lasting physical, emotional, behavioral and financial impacts. Individuals report loss of trust in the health system and some avoid not only the clinicians and facilities involved in the error, but health care entirely.” “Politicians have focused on reining in cost increases and improving access to treatment,” according to the Boston Globe. However, the Lehman Center study, one of the most comprehensive examinations of medical errors, suggests that these elusive goals of cost-containment and improved access could benefit from greater attention to how providers deal with their mistakes.

The study noted that two-thirds of those who were injured, “Expressed dissatisfaction with how their health care providers communicated with them after the errors,” but an important and promising finding is that in instances where providers exhibited greater open communication, patients report less emotional harm and health care avoidance. In November 2012, Massachusetts reformed its medical malpractice system to promote greater communication about medical errors and to apologize for such events. This program, to date implemented in some of Massachusetts’ larger hospital systems, has shown promise in reducing malpractice claims and restoring trust. The issue of lost trust is a factor increasing health care costs since patients who are reluctant to use the health care system often delay seeking care until their condition worsens and is more costly to resolve. They may seek alternative treatment methods and providers. When delaying treatment is no longer an option, patients often utilize the high cost of emergency department services.

The Lehman Center study key findings revealed that 66 percent of respondents were less trusting of the health care system after a medical error, while only 3 percent were more trusting and 31 percent reported no change in their opinion of the system. The trust gap reveals the significant lack of communication by providers when errors occur. Providers who were open and transparent, accepting of responsibility and offering apology saw a significantly higher level of trust among their patients. Where there was little or no communication, 78 percent of patients avoided the doctor and 80 percent avoided the facility, compared to 30 percent and 21 percent respectively with providers that offered open communication. Patients reported that where providers communicated effectively, “The patients experienced less emotional harm and health care avoidance.”

Policy makers and health care leaders need to prioritize patient safety and must act to accelerate progress in reducing preventable patient harm in all health care settings, the Lehman Center concluded. “Meaningful progress on patient safety will require a coordinated, sustained, multi-stakeholder effort with a wide range of stakeholders and experts assuming leadership and responsibility,” according to the study. This is the key to improving quality of care and containing health care costs.

Author: Richard T. Moore has served in both elective and appointed public office at local, state, and federal levels of government. He served for nearly two decades each in the Massachusetts House and Senate, as well as being chosen as President of the National Conference of State Legislatures. He also served in Washington, DC as Associate Director of FEMA in the Clinton Administration and as a Presidential Elector in 1992. A former college administrator and adjunct assistant professor of government at Bentley University and Bridgewater State University, Mr. Moore is a long-time member of ASPA serving terms as Massachusetts Chapter President and National Council member. He was the lead Senate author of the landmark Massachusetts Health Care Reform law (2006) and of the Massachusetts Health Care Cost Containment law (2012) and the driving force behind the establishment and funding of the Betsy Lehman Center for Patient Safety.

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