How do we change the conversation on health care?

What we measure matters

“The financial realities for hospitals are at odds with other things we might want hospitals to do.” — Shannon Brownlee

In our current American health care discussion, we might think the prices of our medical goods and services are the only things that matter.

But cost is a metric only a robot could love. I don’t truly believe that any human being only wants the lowest possible cost of health care. Policymakers are not monsters. Everyone wants our health care systems to keep people healthy and well-cared-for. We want the money we collectively spend there to better our lives and our communities.

How, then, do we measure those things? How do we get them to matter?

In a world dominated by Top 10 lists and data algorithms, a Massachusetts-based think tank has an idea. They call it the Lown Index for Social Responsibility. Researchers took 54 metrics of 3,000 different American hospitals and weighted them to determine what they posit are the medical centers producing the most social good for their communities.

This week, I published a piece with The Lund Report showing how Oregon hospitals stacked up and naming the top hospital on this list in my state. Click through the link to read the full story, but it’s not much of a spoiler to say that the top names in U.S. health care did not do very well in these rankings. Many were dragged down by huge pay gaps between executives and lower-class employees, low diversity and sparse investments in community health programs.

If these were purely capitalist enterprises, perhaps it would make more sense that our hospitals resemble large corporations. But, of course, most hospitals are semi-public, enjoy large tax breaks, rake in public money and tend to be some of the largest employers in any given area.

As I quoted Lown Institute President Dr. Vikas Saini in The Lund Report article:

“We want [people] to think about these rankings more like: ‘What kind of health care system do we have, and is that the one I want for myself, my community and my country?’ […] I don’t think we want a system that has no soul, even if we live forever.”

Unfortunately, the Lown report didn’t include children’s hospitals. I asked Dr. Saini if they could track outcomes across the silo of prenatal care to the silo of pediatric care. They couldn’t. There are no data sets they know of like that.

Anecdotally, I hear a lot of mothers connecting their personal experiences with the health care system during pregnancy and labor to the lifelong challenges their children face. But their stories aren’t enough. Stories of female pain or childhood woes are not enough.

They’re not considered real until they are data.

Maybe not even then.

Ultimately, changing the conversation on health care will require those who hold all the power in that discussion to be willing to participate. After three weeks of requests for The Lund Report story, Legacy Health Systems eventually declined my invitation to comment on the results.

It made no sense. Here was an opportunity to talk about what was working in health care, but they couldn’t find the time.

We’re stuck in the Top 10 lists, and the headlines, and the hot takes. We’re not talking about the things that matter. Rather than a deep, holistic conversation about what we want health care institutions to do, we are trapped reacting to the latest controversy…and blind to any information that hasn’t been approved by a PR team.

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Medical Motherhood’s news roundup

• From the Kansas City Star: “Missouri lawmaker demands explanation for stalled disabled children’s home health program

A Missouri lawmaker is demanding that the state budget office explain why officials haven’t started a program, passed twice by the General Assembly, that would pay parents of disabled children to care for them amid a shortage in-home nurses.

• From the Chicago Tribune: “Former children’s charity director gets 3½ years for stealing from program and blowing it on lavish trips, sports tickets

As executive director of the American Friends of the Israel Sport Center for the Disabled, Nitzkin oversaw the 60-year-old charity’s mission of empowering physically disabled children to participate in physical and psychological rehabilitation through sports. […] According to Nitzkin’s plea agreement with prosecutors, he stole hundreds of thousands of dollars from the charity over a five-year period beginning in April 2011, including directly taking cash from donors and using it to pay personal expenses.

• From Spectrum News: “New law extends child support for adults with developmental disabilities

The measure approved this month by [New York] Gov. Kathy Hochul allows parents of children with developmental disabilities to petition courts to receive support payments until their child is 26 -- providing expanded years of support for families. 


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