“Mortality amenable to health care” is a statistical measure of the, well, mortality amenable to health care.  Briefly, it’s a measure of how many of a population’s deaths from certain causes could have been prevented by proper health care, or as the authors of a recent paper put it: “potentially preventable with timely and effective health care”.  It’s a statistic which in itself means nothing (it won’t tell you whether your grandmother’s death could have been prevented by timely and effective health care), but which can be used to compare different populations (like, people in different countries or (in the US) different states, and to track changes over time in the health care being provided to a population (if the MAHC is rising, then either the timeliness, quality, or amount of health care available to the populations is falling).

In a recent study reported by the Commonwealth fund (in the Journal of Public Health Policy, citation at the link), a group of three authors found significant differences between the various states in this measure, ranging from a low of 64 per 100,000 in Minnesota to a high of 142 in Mississippi (what a surprise) and a whopping 158 in the District of Columbia (bet it’s not among politicians, and also not a surprise).  Furthermore, they found that the US placed dead last in this measure among the 19 developed nations for which data was available from the OECD.  (The lowest?  France, at 65 per 100,000.  France, people.  Seriously, that sucks so much I can feel the interstellar vacuum getting harder).

Even better, the authors showed that there were some hard indicators of which regions or populations were going to have high MAHC, based on already measured public health indices.  Number of diabetics getting recommended preventive care, visits to emergency departments(1) by asthmatics, readmission to hospitals of recently discharged people, and admission to hospitals of long-term nursing home residents were all indicators of high MAHC.  These are the kinds of measures which doctors are railing against (well, to be fair, many doctors.  Other doctors, like me, are cheering the measures, and demanding they be used to provide the public some openly available information about the health care providers in their region).  Because many doctors feel both helpless to change those numbers, and trapped by a reimbursement system which, in effect, punishes them for making the numbers better.  This doesn’t work so much on an individual level: ask a specific physician whether they’d like to fix those numbers, and they’ll all tell you “Of course!”, but it works in subtle ways.  Fixing the numbers means working together with people who have traditionally been, not enemies, but rivals: hospital administrators, nursing home administrators, politicians in some cases.  And as you fix them, you watch your income figure drop, and suddenly there are just…other priorities.  Going to the meetings that keep the “fix the problem” process on track becomes less important.  Maybe you are frustrated with one of the other participants, and decide to say so to your colleagues, or the other members, or, heavens forfend, the media.  And suddenly the process is derailed; these things happen, couldn’t be helped, back to business as usual.  It’s never so open as “I decided to kill the process because it killed my income stream”, but that’s nevertheless what happened.

When it comes time to make the kinds of changes we need to make, I believe it’s crucial to 1) acknowledge the fact that income is a factor, and take steps to minimize and equalize the impact, and 2) see that the process keeps going, despite the lost income.  Maybe, after a while with the new system, new income streams will be found which encourage doing the right thing-that’s always been my thinking.  And one of my fondest hopes.

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1) Never “Emergency Room”.  It’s the “Emergency Department”. That’s probably the only absolute in the Physician’s Pen style guide.