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totaled slightly less than $1.5 million.105 Bloom has estimated that $3.9 billion was spent in 1983 to manage the preventable gastrointestinal adverse effects of nonsteroidal anti-inflammatory drugs.106

Medication-related errors also occur in nursing homes. For every dollar spent on drugs in nursing facilities, $1.33 is consumed in the treatment of drug-related morbidity and mortality, amounting to $7.6 billion for the nation as a whole, of which $3.6 billion has been estimated to be avoidable.107

Public Perceptions of Safety

Although the risk of dying as a result of a medical error far surpasses the risk of dying in an airline accident, a good deal more public attention has been focused on improving safety in the airline industry than in the health care industry. The likelihood of dying per domestic jet flight is estimated to be one in eight million.108 Statistically, an average passenger would have to fly around the clock for more than 438 years before being involved in a fatal crash. This compares very favorably with a death risk per domestic flight of one in two million during the decade 1967–1976. Some believe that public concern about airline safety, in response to the impact of news stories, has played an important role in the dramatic improvement in safety in the airline industry.

The American public is aware that health care is less safe than some other environments, but to date, it has made few demands on the health care industry to demonstrate improvement. In a public opinion poll conducted by Louis Harris & Associates for the National Patient Safety Foundation, the health care environment was perceived as "moderately safe" (rated 4.9 on a scale of one through seven where one is not safe at all and seven is very safe).109 Respondents viewed the health care environment as much safer than nuclear power or food handling, but somewhat less safe than airline travel or the work environment.

Americans have a very limited understanding of health care safety issues. When asked, What comes to mind when you think about patient safety issues in the health care environment? 28 percent of respondents did not mention anything, 20 percent mentioned exposure to infection, 13 percent cited the general level of care patients receive, and 11 percent cited qualifications of health professionals.110 When asked about the main cause of medical mistakes, respondents most frequently cited carelessness or negligence (29 percent) of health care professionals, who are overworked, worried, or stressed (27 percent).

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