Study: Health care system needs help

Despite billions of dollars spent for preparedness, health care systems are poorly equipped to respond to a major disaster, according to national study.

BY STAFF REPORT | December 28, 2007



"When a disaster hits, Americans rely on a fragmented health care system to miraculously mount a timely, cohesive, and effective recovery effort. Yet, the carefully orchestrated and sequenced medical responses. . .lean on a disjointed health system."

—PricewaterhouseCoopers


Despite the federal government appropriating nearly $8 billion for disaster preparedness since 2002, the U.S. health care system is poorly equipped to respond to a major disaster with disaster planning remaining "sporadic" and "disconnected," according to a national study.

"When a disaster hits, Americans rely on a fragmented health care system to miraculously mount a timely, cohesive, and effective recovery effort," said the report by PricewaterhouseCoopers' Health Research Institute. "Yet, the carefully orchestrated and sequenced medical responses to disasters lean on a disjointed health system."

The report, based on interviews with top health industry leaders and 1,000 adults, said that while "significant progress" has been made since the terrorist attacks of Sept. 11, 2001, "gaps continue to exist."

"We found that facility and staff resources are limited, public health and private medical sector plans are inadequately coordinated, communications and tracking systems are incompatible and funding is not sufficient to support development of a sustainable infrastructure for an effective response," it said.

Another report, this one by the Trust for America's Health (TFAH), found that while progress has been made, more work remains to be done on the nation's emergency health preparedness effort. The report was issued after the PricewaterhouseCoopers' study.

"The improvements in state preparedness are encouraging, but the job of preparing the United States for major health emergencies is not nearly done," said Jeff Levi, executive director of TFAH. "And, just when we are beginning to see a return on the federal investment in preparedness programs, the president and Congress have continued to cut these funds. These efforts may seem penny wise now, but could prove pound foolish later."

The TFAH report evaluated all 50 states on 10 key indicators. Thirty-five state scored eight or higher, with seven states Illinois, Kentucky, Nebraska, New Jersey, Pennsylvania, Tennessee and Virginia scoring a perfect 10. Six states Arkansas, Iowa, Mississippi, Nevada, Wisconsin and Wyoming scored the lowest with six out of 10.

The report found that seven states and the District of Columbia do not have the capabilities to test for biological threats; seven states have not purchased any antivirals to use during a pandemic flu, which TFAH said "places the entire nation at risk," and 21 states do not have statutes for adequate liability protection for healthcare volunteers during emergencies.

"There is little doubt that emergency health preparedness is on the national radar," Levi said. "But until all states are equally well prepared, our country is not as safe as it can and should be."

Among the findings in the PricewaterhouseCoopers' study:

- No universally accepted definition of "preparedness" exists, making it difficult to establish benchmarks.

- Little coordination exists between hospitals and public health workers or other frontline caregivers.

- Disaster planning by communities and states is "highly variable and without standards."

- Primary care physicians are the least likely to be prepared or to receive disaster preparedness training.

- Federal funding for hospital preparedness has fallen steadily, with spending today "less that $5 per person annually for health systems and agencies to be prepared for a disaster.

"More money is now spent to stockpile drugs and supplies than to hire and train health providers and treat disaster victims," it said.

- Communities are under no federal or state mandates to maintain a certain level of hospital capacity for disasters.

"Most health system resources are owned and operated by private organizations that are pressured to improve their operational efficiency and financial bottom line," the report said.

Chief among the report's recommendations was that the health care system make a "dramatic shift" by redirecting its focus in a disaster from trying to save every person to saving the most people.

"Hospitals need to decide how they will free up capacity, plan for delivering care in unconventional locations, recycle supplies to extend limited quantities and ration resources to care for those most likely to survive," it said.

"Moving the health system from a focus on individual outcomes to population-based outcomes - saving the most people rather than every person in a disaster - will continue to challenge leaders, practitioners, staff, administrators and the citizenry," it added.


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