Dr. Ben Smith: Health care ‘data’ startlingly divorced from the realities
As an emergency doctor and the director of a small Vermont emergency department, I am glad to see some of Vermont’s health policy thinkers embracing investment in outpatient services like primary care, mental health, home health, and in the social determinants of health.
The hallways of emergency departments nationwide, including here in Vermont, are a vivid, gut-punch tutorial in the social determinants of health and the paucity of outpatient care. These investments are desperately needed, as are major investments in nursing home care.
Worth questioning, though, is the notion that any of these investments can be made simply by reallocating money from emergency and hospital care, which is often characterized as “avoidable” and “low-value.” Although there is data to suggest the magnitude of the so-called avoidable care problem, supposedly on the order of 30% of emergency and inpatient stays, this data is startlingly divorced from the following realities on the ground: