Welcome to Center for Advancing Health

We all like to think we are wise consumers, having had much experience buying groceries, cars, TVs and other everyday commodities. But when it comes to health, we are a nation of ignoramuses. That's due partly to the wizardly aura that the medical profession has created around itself but also due to the fact that most of us don't think about getting sick until we do.

To be a better consumer, however, may require an economics degree. A recent report by McKinsey Global Institute examined the gaping disparity between the cost of health care in America and in other industrialized countries, where health outcomes are about the same or better. The report documents that 3.6 percent of the U.S. economy, or $477 billion, is wasted each year in unnecessary medical spending. And a report by government accountants predicts that health care spending will amount to 20 percent of the nation's economy in the next 10 years.

What it means is that as insurance premiums rise to pay the cost of health care - whether privately or publicly funded - the consumer will be paying a larger share out of pocket. And that means making more complex individual decisions on when you need medical attention, how much of it you need and where you will have your needs best met.

The perversity of the American health economy is seen in data reported in the Annals of Internal Medicine, which finds that medical students are shunning primary care as a specialty because it pays so little, even though it is the internist who is supposed to be the gatekeeper in any rational system of allocating services, and even though studies show that patients
with a regular primary care physician have better health at lower cost.

The author, Thomas Bodenheimer, blames a committee of the American Medical Association that reviews physician fees, a committee dominated by specialists. The free market result is too few primary care doctors, increased waiting time for an appointment and less attention to patients when they get one. So unless a health consumer is so sick as to require hospitalization, he or she might forgo routine doctor visits and preventive care rather than be sentenced to hours reading last December's People magazine in a crowded waiting room.

When they do get an appointment for the condition that is disrupting their lives, people are probably going to have a list of other concerns that need attention. And a responsible doctor is going to want to at least make note of basic prevention issues such as cancer screening, flu shots or smoking cessation. However, neither agenda is going to be adequately fulfilled unless the economics of health care refashion incentives for both doctors and patients to act in their best interests.

Different solutions will be proposed over the coming election season, but patient passivity will no longer be an option - either in the doctor's office or in the politics of health care.

AFTERSHOCK Publicity for Center President Jessie Gruman's new book, "AfterShock: What to Do When the Doctor Gives You -- or Someone You Love -- a Devastating Diagnosis," is in high gear with Dr. Gruman writing about it in the Washington Post, talking about it in a Q-and-A in U.S. News & World Report and appearing on local television in Washington and Norwalk, CT. The book also was mentioned in Harper's Bazaar.

SLEEPLESS Dr. Gruman was quoted in a New York Times article about how sleep disorders are not necessarily a medical problem but a fact of life like baldness or menopause.

DIVERSITY DATA Senior project director Barbara Krimgold, who runs the Kellogg Health Scholars Program, was quoted in the Washington Post about the Center's successful launch, with Harvard School of Public Health, of a Web site, www.diversitydata.org, which offers the public urban quality-of-life data based on census figures and broken out by various socioeconomic indicators.

CONSUMER ENGAGEMENT Dr. Gruman and the Center's Margaret Holmes-Rovner participated in a meeting sponsored by the Robert Wood Johnson Foundation and Academy Health to review briefing papers on "Improving Quality Health Care: The Role of Consumer Engagement."

TRANSITIONS Science writer Taunya English has taken on the new position of associate editor for the Health Behavior News Service. She will be working with HBNS editor Lisa Esposito to select and edit reviews and studies. She will continue to write original features and articles. After nearly seven years with the Center, Vice President for Public Affairs Ira Allen is leaving to resume his prior consulting and freelancing practice.