By NextBestFitMedical errors and poor care coordination
Failures of care delivery and coordination waste an estimated $129–244B a year and cause preventable harm.
Evidence
- Failure of care delivery $102–166B; failure of care coordination $27–78B a year.
Who's affected
- People with ongoing or specialist care needs: Delivery and coordination failures cause preventable harm.
- Hospitals, clinics, and care organizations: Fee-for-service providers are paid for treating complications.
Under your mix of paths
- Fragmented records
- Payment for volume rather than outcomes
Related costs
Open questions
- How should providers be paid: per service, per patient, per episode, or by budget?
Caused or worsened by these paths
This problem only matters if one of these paths is chosen.
Without selective contracting, weak providers retain patients they might otherwise lose.
Mail delivery can be unreliable for temperature-sensitive drugs.
Keeping low-volume rural hospitals open can still leave lower quality for some procedures.
Keeping labor units ready locally reduces risky long drives during labor. Standby payments also keep low-volume units open, where outcomes may be worse.
Covered rides depend on brokers whose reliability records are poor.
Allowing international physicians to practice without repeating residency raises quality assurance concerns.
Artificial intelligence documentation can produce notes containing errors.
Phasing in tighter staffing ratios delays safety gains.
Solution paths (2)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
National no-blame reporting of adverse events, with public reports and investigation.
- +Medical errors and poor care coordination
- −Makes performance and quality hard to oversee
- −Depends on other changes to work
Each resident registers with a primary care practice responsible for coordination.
- +Medical errors and poor care coordination
- −Limits choice or applies one rule to every setting
- −Physician shortage, especially in primary care
Also addressed by paths for other problems
Keeping labor units ready locally reduces risky long drives during labor. Standby payments also keep low-volume units open, where outcomes may be worse.
Enforceable nurse-to-patient ratios make care safer.
Stopping coverage of services proven not to work protects patients from harmful care.
Shifting care from large institutions to small homes and home care reduces infections.
A national record that follows patients reduces medication errors.