Health Care Experiments, Health Care labs, Health Care Choice
Wednesday March 10, 2010
Today's
Zinger:
The Morning Briefing:
Over the past 25 years, medical care has become more and more specialized. For the patient, this has meant an improvement in quality of care in some cases, but it has also meant a decline in care for others that don't have access to care due to cost or a decline in care due to the difficult coordination across providers.
The number one predictor of a successful medical outcome is the number of times the providers have seen and dealt with a specific medical problem. This means the more specialized a doctor or facility at dealing with a particular problem the better the patient outcomes. From the doctors or providers standpoint, this specialization has also meant higher incomes. Specialization has a higher Medicare and insurance reimbursement than general practitioners.
Medical specialists have also learned that owning side businesses to support their practice is convenient for the patient and very profitable as well. Laboratories, Imaging Centers, Pharmacies, Surgical Centers have sprung up to support individual doctors practice needs. These centers have further splintered the medical delivery system.
The Discussion:
There was a time that health care was highly integrated. You went to a doctor, hospital and pharmacy and received most of the care from one or two "profit centers". Not today. As my wife experienced with her surgery, 27 different providers with their own profit centers, surgical centers, imaging centers, doctors, hospitals, medical transport, etc get involved. Each creates some level of redundancy and some level of medical testing that may or may not add to the patients outcome.
Each also creates an extraordinary cycle of billing and paperwork. Each creates their own bill to the insurance company and a bill to the patient. The insurance company creates an Explanation of Benefits Statement (EOB) to the provider and then an EOB to the patient. The bill is usually revised at least once which produces another EOB to the provider and then the patient. Then the provider must produce another bill to the patient. Each provider contact will produce a minimum of 5 billing/EOB events and more likely 7-10 events. This means that my wife's surgery and followup produced over 100 administrative contacts. All of this drives costs. All of this creates the potential for errors.
The reason that the Single Payer System sounds appealing to so many people is that it will eliminate the redundancy across providers. It will also radically alter the health delivery model. It will force the integration of providers and eliminate the incentives that drive some providers to adopt procedures or business options that enrich their practice but does not necessarily increase patient care.
Some European countries have a 2% administrative cost associated with their health care systems. In the United States, it is fair to say that ours is somewhere between 20-25%. These European countries also have doctors on salary rather than incentives that produce more tests and side businesses that produce higher income. There are few medical facilities in the United States that operate under a similar philosophy. Mayo Clinic, Cleveland Clinic, Everett Hospital are examples of a few. These centers are known for lower cost and higher patient care. Doctors are on salary and efficiency of medical delivery is of paramount importance. At the same time these facilities are known for their excellent patient care.
So the question should be asked, is there a way to radically reduce medical and administrative costs without going to the single payer system that we often find in Europe? Absolutely. Reintegrate our medical delivery system, provide incentives for both patients and providers to more efficiently use medical care, remove incentives that are financially motivated and not medically motivated, build the health information network to improve coordination of administration and care and improve medical outcomes. These are just a few examples that could truly bend the cost curve of health care. The problem is a willingness to make the tough decisions.
Kaiser Health News (KHN) is
a nonprofit news organization committed
to in-depth coverage of health care policy and politics. Kaiser Health
News is funded by the Kaiser Family Foundation, a non-profit private
operating foundation based in Menlo Park, Calif., which communicates
analysis and information
on health issues. The Kaiser family is also affiliated with Kaiser
Permanente, the California based health care provider. My reading of
the foundation reports does not indicate a bias toward the health
providers.
The following article talks about the role of health care experiments in finding the best way to cut costs and improve quality of health care. It looks at the example of how a Medicare experiment in the 90's to combine costs/services of doctors and hospitals for Medicare resulted in a 10% cost reduction, but was never implemented because Congress bowed to the powerful lobby of the doctors and hospitals. Here is the link that will open in a new window. KHN Report.
President Obama has recommended that we adopt a test of tort reform in a limited market to determine the value of reducing awards associated with medical malpractice. The Republicans are recommending a slow as you go approach to test various alternatives and see how they work. Will the test of any health care alternative be anything more than parking lots of politically difficult decisions?
The Conclusion:
As a nation, we know
that we cannot afford to let the health care situation continue. We
have a choice. Go to a single payer system or reintegrate and improve
the efficiency and effectiveness our our current system. Each has its
pros and cons, but each will require a political strength yet to be seen
in our government. The worst thing we can do is a partial fix because
it won't really fix the situation and has the real potential for making
it worse.
If our politicians continue to see health care as a political win or loss then the wrong decisions will be made. Now is the time to come together and make the tough choices. If we don't, this could be the canary in the coal mine for our democracy. Something this big and important that goes without proper resolution will surely lead to similar results for education, national debt, immigration and war resolution.
The Democrats see health care as a real threat to their political power. The Republicans see it as a real opportunity to regain control of Congress, We The People see heath care as an urgent national need.
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Categories: Legislation, Social Issues, Healthcare
Tags: Health Care Legislation Healthcare
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