|
Rate This Blog
 0 rating(s)
Archives
Latest Entries
Loading...
Links
Loading...
 |
Healthcare Efficiency
Explore the delicate balance of efficiency and quality care.
Getting Closer
Posted by:
Robert Burney on
September 12, 2009 at
2:42PM CST
There is more talk about money these days. Harold Miller talks about the financial issues in health reform on the Health Affairs blog, but he fails to propose an effective strategy. Like many, he relies on prevention to produce cost savings. At the very least, it takes a long time (maybe forever) for the savings from prevention to offset the cost of prevention. Lori Montgomery of the Washington Post discusses the "mixed esults on cost savings" in part of the Post's series on Healthcare reform 2009. One approach to wringing more value from prevention is targeting, as we do with screening for colon cancer. Screening is more intense (more expensive) if you have risk factors for developing colon cancer. And not every woman needs a PAP smear every year. As we learn more about genetic predispositions, there may be a role for genetics in deciding which screening tools are most appropriate.
All this works, of course, on a population basis but not for individuals. There will still be people who want a colonscopy, even without any serious risk factors. Sort of like getting a PSA every year, even tho the "experts" don't think it's cost-effective for the population.
Miller also talks about improving the quality of healthcare, forgetting that we already have pretty good care. We just need cheaper care. Still good, but cheaper. Before you laugh, remember that other industries have done this. Competition does this. AT&T is a classic example of a benevolent monopoly but I suspect if they still owned the phone networks, your cell phone would have wire you had to plug in to use it. If GM were the only care maker, we'd all think SUVs were the only way to travel. Think also about banking. When's the last time you spoke to a teller? I bank online and don't think my bank employs any tellers, but my transactions are better--faster--cheaper than ever.
In a 9 Sep editorial, the Washington Post declares it crucial for Congress to "pay for reform without gimmicks and structure structure reform so health-care costs stop rising."
The NY Times documents efforts by various components of the healthcare industry to modify parts of health reform that they feel might impact their profits. In other words, almost everyone is working for the status quo. There's a line from Machiavelli about those who advocate a new order but find no friends among those who benefit from the old system. In actual fact, it's change we fear. True, not all change means improvement, but any improvement will require change.
And of course, no mention of costs in healthcare would be complete without mention of Atul Gawande's New Yorker article, "The Cost Conundrum" about the free market approach gone amuk in McAllen, TX. If nothing else, this study demonstrates again that the potential market for healthcare is infinite when someone else is paying for it. In that setting, there was no limit on the amount of healthcare any citizen could receive, and all providers were paid at standard rates for whatever they provided. This erases any economic disincentive for a new provider to enter the market. And the taxpayers paid. This article received a lot of attention, tho the many used it to support their point of view without analyzing the causes.
Many would be more receptive to reform if more credible ways were found to pay for it.
Send This | Categories:
|
|
