discussion on frances system

Tue Jan 8 16:57:35 GMT 2008

Mark,

I'm not familiar with the 9 - global period so take my comments for what
they're worth. I worked at Cook County Hospital in Chicago. The mission of
that institution was to provide quality care for the medically indigent. I
originally trained in medicine.

It IS very important to analyze the methodology in studies like this and
obviously we can't do that from the snippets on the internet.

Patients using the trauma systems in our country have good access to
emergency injury care, assuming they live in an area with a trauma system.
Lack of insurance would not be a barrier to such access. (And injury, is by
definition, preventable but we won't go there now)

Everyone in Chicago could come to County whenever they wanted and eventually
be seen. I believe we did a good job of providing quality care. Was the care
the same as patients with insurance going to one of the adjacent
institutions? Absolutely not. Was access to timely and excellent care
especially in the interest of minimizing preventable morbidities and
mortalities a huge issue? Absolutely. Patients at County hospital suffered
morbidities and death from common conditions that in general they would not
have if they had better access to a continuum of good care. Things were OK
when they were in the hospital, but we couldn't keep them in the hospital
all the time. My patients couldn't afford bus fare to come to clinic if I
wanted to see them an extra time. In the last few years the number and
demographics of people seeking care at County has increased dramatically
because more and more people have lost their health insurance.

Americans are used to being the best and expect to be the best and we
should. But lots of studies have suggested there are measures that may show
our health care system may not be the best. Again I agree we should
carefully look at the methodologies of such studies. But instead of getting
angry at the studies, let's get angry at ourselves and the forces that are
compromising our ability to provide the best health care SYSTEM for
everyone. And work together to fix them.

Rob Smith, MD, MPH
Chair (ret) Div Pre-hospital Care and Prevention, Dept Trauma, Cook County
Hospital

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Marc Matthews - MedPro MMC X
Sent: Tuesday, January 08, 2008 8:21 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: discussion on frances system

All,

I work in a "County" medical center in Arizona called Maricopa Integrated
Health Systems. Everyone in Arizona, no matter where they come from, gets
"free healthcare", if they do not have a cent and need medical assistance.
Many, if not most of my patients, do not have insurance yet they have
unfettered access to me and many physicians. This even includes anyone from
south of the border that becomes sick in the United States and subsequently
needs help. So the statement, "Nolte said the large number of Americans who
lack any type of health insurance -- about 47 million people in a country of
about 300 million, according to U.S. government estimates -- probably was a
key factor in the poor showing of the United States compared to other
industrialized nations in the study", is probably not as accurate as he
would like to believe. Laws such as EMTALA, make sure that if you do not
have insurance, you will still receive care and I would suspect that if you
live in AZ, CA, KY or any state (places that have similar county or
university hospitals), you get care on demand without the demonstrated
ability to pay. Certainly this means life-saving care. 

So, exactly what were they looking at to come to these conclusions? Is he
talking about follow up? Has he heard of a 9- global period? Patients are
still eligible to get care in AZ and I am sure many states as we have ways
to do help patients especially through Medicare and money via foundations,
so again statements like this, ""I wouldn't say it (the last-place ranking)
is a condemnation, because I think health care in the U.S. is pretty good if
you have access. But if you don't, I think that's the main problem, isn't
it?" Nolte said in a telephone interview", are not exactly accurate or else
the study has a flaw(s) that have led them to an inaccurate conclusion.
While we are not perfect and are constantly a work in progress, much like
our democracy, I doubt that in the industrialized world we are last. 

I am also getting more than a little tired of the United States being
maligned and bashed.

Sincerely,

Marc R. Matthews, MD, FACS
Medical Director of Trauma Services 
Maricopa Integrated Health Services

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-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Mike Smertka
Sent: Tuesday, January 08, 2008 5:51 AM
To: Trauma &amp, Critical Care mailing list
Subject: discussion on frances system

Happy new year everyone. 

  I thought this headline was interesting considering all the talk about the
French Trauma prehospital system as of late. I know this doesn't break down
trauma from respiritory infections in neonates, but I thought it was worth
considering:

  http://news.yahoo.com/s/nm/20080108/hl_nm/deaths_rankings_dc

  Basically it says france rated first in preventable deaths and Us was much
lower on this list.

  Mike

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