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Shooting from the hip

Health care and radar politics make strange bedfellows
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April 30th, 2008 issue

By Ivan Kalman

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Since the Velvet Revolution, Czech officials have worked hard to upgrade to state-of-the-art technology in all industries, including health care and defense.
In fact, recent political developments show that these two wildly different industries are actually linked.
In health care, Czech officials now use a U.S. patient classification system called IR-DRG. The computer system groups hospital patients who have similar clinical and cost profiles together — the idea being to analyze similar patients in order to give them better care while keeping healthcare costs in check.
Czechs got the IR-DRG system for free, thanks to the generosity of 3M, which developed it. But they have had problems making it work well, mainly because of poor patient documentation and the fact that they had to accommodate the use of previous treatment codes, which the system was not programmed for.
Other countries in Europe actually rejected this particular U.S. system, after careful evaluation, including Germany in 2002, Ireland in 2005 and Switzerland in 2006.
Czech officials recently asked the European Commission (EC) for help to make the health documentation system easier to use.
But we’ll come back to the health care bureaucracy issue in a minute — let’s move to politics.
We all know that U.S. officials want the Czechs to install a radar system to serve as part of a global early warning anti-missile shield. Agreements between the two countries are expected to be signed May 5. As part of the shield, Poland has been asked to host 10 missiles.
When Czech Prime Minister Mirek Topolánek recently visited Washington to discuss the radar deal, he brought a wish list of things the Czechs want in return.
One of the things on the list was a new medical treatment classification system, since Czech Health Ministry advisers had heard that the U.S. government had paid to develop one already.
U.S. President George Bush was delighted to find out that Topolánek supported him on the radar. Not wanting to have his guests leave empty-handed, he approved a visa-free program for Czech visitors to the United States. His advisers recommended that the new treatment classification system be thrown in as well.
So not only was Bush happy, but Topolánek was happy, too. Czech health minister Tomáš Julínek was told that he would get his new treatment classification system.
No one really worried about the compatibility issues between the existing IR-DRG system and the new treatment classification system, since the classifications come from the same U.S. company. Czech advisers and deputy ministers discussed the matter and decided just days later to adopt the new treatment classification system.
Remember we said the Czechs had already asked the EC for help?
At a meeting several days later, a European adviser suggested several alternative treatment classification systems. The American one was not on the list of feasible alternatives, since it has not been adopted and used in Europe or in the United States, the adviser said.
After the Czech Health Ministry representative thanked the expert, he announced to the astounded audience that the U.S. system was the one that had been chosen.
All hell broke loose. The ministry coordinator was asked for a justification, but could not provide one.
Local experts feared being sidelined. Czech health officials lost huge credibility with their own experts, and it will be difficult to go back to them or the Europeans for their help in the future.
Critics of the decision accused the Health Ministry of using cowboy politics and of shooting from the hip.
If Bush had heard that, he would have felt right at home, since he has perfected the science of shooting from the hip over the years. In fact, he would probably have said that to shoot accurately from the hip requires first and foremost a steady and healthy hip.
By some bizarre relationship, Czech health officials have been concerned lately with how many people in the aging population need hip and knee replacements. They want to convince health insurance companies to provide attractive reimbursement for such surgeries.
So the agency that maintains the Czech version of the original U.S. patient classification system was asked recently to analyze how many hip and knee replacements have been performed in which hospital.
Results of the study have been published in Mladá fronta Dnes. It will now be easier to predict which hospital is likely to provide the best quality hip replacements, so shooting from a healthy or reconditioned hip can continue.
Maybe the lessons politicians learn in putting two initially incompatible healthcare systems together can be applied to the radar defense issue as well.
We have all heard that Russian President Vladimir Putin wants to station Russian military observers at Czech radar and Polish silo sites as part of the radar base agreement. This comes 17 years after the last such observer left the country.
Let me offer a tongue-in-cheek solution:
Putin’s idea must enrage Czech patriots.
In response, government officials could intensify their efforts to deliver artificial hip and knee replacements, which would give our soldiers a special advantage in the unlikely event that Polish-based warheads failed, or if Russian warheads were to be fired at the Czechs to force them to their knees again.
Shoulder-to-air missiles, which are fired from a kneeling position, could be deployed. Classes on shooting from the kneeling position and from the hip should be offered to all Czech patriots.
It all appears to fit together nicely. This story of interdependent health care and radar politics involving international transfer and deployment of technologies, with its ironies, twists and turns, should elicit at least a smile.
On a related note, let me mention an international healthcare conference this month in Prague, where experts exchanged views on how to help healthcare consumers make good choices.
The Czech health minister, in his keynote address, reminded the audience of the challenges in health care by saying, “The road to health is paved with good intentions.”
Based on the latest news, the Czech defense minister is dealing with the defense lobby by saying, “The road to defense is studded with Patriot missile batteries.”
In Prague — where humor and military-related stories have a tradition, as in Hašek’s famous novel, The Good Soldier Švejk — humor and health care have recently joined too (while shooting from the hip).
— The author is a healthcare consultant who has worked in the medical information and analysis field for almost 30 years. He manages an information services company in Germany.


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[17:43 02/05/2008] : The irony of the linkage of the Minnesota-produced 3M patient tracking system IR-DRG to the proposed U.S. missile defense system is not lost on this writer.
Minnesota is the home of 3M and also the location of a major interstate bridge which collapsed last year.
Highways, bridges, tunnels, ports and railways all comprise our aging infrastructure and are a major national security issue in the United States in need of support and funding.
The U.S. economy is close to recession, and approving treaties calling for dubious funding of unproven technologies is a disservice to the U.S. taxpayers and Czech and Polish citizens.
There may indeed be an agreement signed between the Czech government and U.S. officials on May 5.
As Vice-President Cheney recently observed in an interview, "So?"
I wonder if Prime Minister Topalánek and other Czech military officials coordinated their wish lists before the recent visit of the prime minister to Washington, D.C.
Recent reports of Czech military officials asking the United States for two additional C-130 transports and an updating of the Czech anti-missile defense system may satisfy Czech political ambitions but it seems that the left hand does not know what the right hand is doing.
If Czech officials think the integration of a U.S.-designed patient tracking system into the Czech health care system is fraught with complications; try imagining the integration of the missile defense tracking system whose testing in Alaska and Central California has been less than successful.
The flawed performance of the U.S. missile defense system was not overlooked by the U.S. Senate Armed Services Committee, which cut funding for this project by $139 million in July of 2007.
The same U.S. Senate will be the major hurdle for ratification of the treaty approving the missile defense system.
In the interest of worldwide food shortages, I suggest Czech and Polish agricultural officials coordinate a plan to approach the European Union and apply for an agricultural subsidy to convert Brdy mountain from swords into plowshares.
So that would mean is that the prime minister would have to coordinate his wish list with agricultural, health and military officials. And Czech government officials should be careful of what they wish for; they just might get it.
Paulette Will
Minneapolis
[11:02 07/05/2008] : Really excellent article! I hope someone will take notice of the content where it matters.
Ludvik Zidek
Veldhoven
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