The greatest flaws in the U.S. health care system are the lack of transparency and good information management, and the Internet should be utilized to improve upon these problems, says Ashish Jha, an assistant professor of medicine at Harvard Medical School.

Jha, who is also an assistant professor of health policy at the Harvard School of Public Health, presented his arguments about the status of the U.S. health care system at a discussion held Tuesday (March 25) at the Berkman Center for Internet and Society at Harvard Law School.

“In 2006, we spent $2.1 trillion in health care, 16.5 percent of the GDP,” Jha said. He said that the average expenditure per person for health care that year was $7,000, a staggering sum in a nation where the annual minimum wage is $11,000.

But the real problem, he argued, is not so much high cost as it is the quality of service that Americans get for their money. Jha quoted a RAND study showing that in only 55 percent of cases are patients receiving proven treatments that have been shown to have a major impact on outcomes. “We’re talking about no-brainers, like giving aspirin to a heart attack patient,” he said. Jha also noted that the number of deaths from medical errors far exceeds deaths in auto accidents.

Among the many reasons for the poor quality of health care, Jha said, are a lack of transparency and poor communications .

“Do you know how much your hospital visit costs?” he asked. “Cost accounting is opaque.” He also said that the available data are not easy to understand, and the procedures used by hospitals to share records are far too complicated. “About 80 to 90 percent of health care is paper-based and there is no adequate feedback loop,” he said.

Jha suggested that having a public report card evaluation system available online would encourage physicians and hospitals to pay attention to their work. “Some have responded by making major improvements in the quality of care they provide,” he said in a separate interview.

He offered the New York State Cardiac Surgery project, a “report card” on hospitals performing cardiac surgery, as a positive example. After physician and hospital mortality rates for cardiac surgery began to be published, the mortality rate in hospitals decreased far more than those in other states, he said.

Jha said that the Internet’s transformative potential in health care has barely been tapped. “One way that the Internet has not, at least not yet, been very influential, is as a mechanism to provide good feedback by patients. As this becomes more commonplace, health care will become far more responsive to patients’ needs,” Jha said.