The article highlights not only how some of these other "evil socialist" systems may be cheaper, but in many ways how they are better. Yes, their costs too are growing too quickly. But, they spend far less of their GDP and their outcomes are similar, if not better. Even when we control for our penchant for obesity in this country, for some reason our outcomes are not nearly as good as we think.
What we have in this country is high technology, highly specialized health care. It is the health care of procedures, gizmos, gadgets, and pills. Instead of focusing on things that could help us in other ways, like looking at education or less reliance on cars, or even things within the health care system, like primary care matters and wellness, we look at the "fun" stuff. We seem to have a sort of cognitive problem here in our health care.
If we focused on keeping people health, the new consensus shows, we can likely reduce costs. And reducing our costs without destroying quality is a major goal. Perhaps we do also need to create incentives to reduce these costs. Whether they are pay for performance quality and efficiency bonuses, or if they are more sticks, like a mechanism that limits growth by cutting pay, we cannot continue in this route. Our system is not helping us be healthy. And it is destroying our fiscal future.
Intereting post. What are your thoughts on how to reduce costs without "destroying" quality (for our purposes let's define quality too). To me, like most things in life, there is a 1 to 1 correlation between higher cost and better quality. Is that so? Can your recommend articles to refute my point?
ReplyDeleteWell when it comes to health care, cost and quality rarely seem to match. The Atul Gawande article in the New Yorker that I have linked to somewhere here is a good case study. Also, if you look at Medicare data, the higher costing regions do not create higher quality. Instead, you actually get reduced quality as costs increase. One of the reasons is that you lead towards higher utilization of services.
ReplyDeleteAnother post that links to quality is the New America Foundation's blog posting from today, which I cite to in today's posting. For convenience it is here. http://www.newamerica.net/blog/new-health-dialogue/2009/msm-wsj-ed-page-and-nice-13106 (it also links to Gawande). Backier did the famous negative correlation study.
There may also be a unit cost rather than utlization problem. For example, certain quality measures are well established like life years added, or measuring patient safety like Medicare does. if you go to the Hospital Compare site, www.hospitalcompare.hhs.gov, you can set up some hospitals. I am sure that there are some hospitals that are considered more expensive per unit than others. However, if you compare the quality outcomes based on Medicare data (which is a decent if skewed because they are older and sicker as a group) you find that what you think is the most expensive is not always the best.
I would start there. I could go digging for more, but it's late, and I'm going to bed.