We Need Long-Term Strategies
Spending on health care continues to rise rapidly and accounts for a growing share of our national economy. Increasing health care costs drive up health insurance premiums. As a result, fewer businesses offer health coverage, millions of Americans go without insurance and even those with coverage pay more when they need care. The cost of care also makes it hard for government to support health care for the poor and elderly.
Many health reform proposals focus on finding someone else to pay for the high costs of insurance and care. Employers want employees to pay more, and workers want the company to pick up most of the tab. Government limits how much doctors are paid to care for the poor through Medicaid, and insurance companies try to negotiate lower provider payments. Such approaches may offer short-term relief for some but don’t address spending for the system as a whole.
Moving beyond efforts to shift costs among payers, there are four long-term strategies to slow overall health spending growth:
• Change the way care is delivered. Not every health condition requires a doctor’s attention or a hospital’s infrastructure. Smart use of lower-cost settings of care, lower-cost professionals, technology and self-care holds promise to reduce costs without compromising quality;
• Change the way care is paid for. Today, most doctors are paid by the visit, and most hospitals have no financial incentive to reduce admissions. A new payment system could compensate providers for health outcomes rather than number of services delivered;
• Encourage prevention and healthy lifestyles so that less health care is provided for preventable conditions;
• Eliminate overuse of inappropriate or ineffective services, drugs, and devices, and encourage appropriate and cost-effective approaches.
Comparative effectiveness (CE) research holds potential to contribute to the fourth approach, eliminating overuse. By reviewing scientific findings to assess what treatment works best, for whom, and under what circumstances, CE aims to bring strong evidence to bear in treatment decisions by physicians and patients. For a particular patient situation, there are often several treatment options – ranging, for example, from watchful waiting to major surgery – with a range of possible outcomes. CE helps patients and doctors assess and choose among these options.
Using CE would result in less aggressive and less costly treatments for some patients, but it would lead to earlier or more aggressive intervention for others. At this point, we just don’t know if widespread use of CE would save money. If there were savings, they would depend on specific findings, and whether those findings changed how medicine is practiced and how insurance companies pay for care.
CE findings won’t change care delivery or cost unless results are accepted by patients and doctors. Only a few conditions and interventions have been extensively studied; but even when findings are clear, Americans have been slow to accept them. For example, a large 2002 study showed that generic drugs are more effective in treating high blood pressure than more expensive brand-name drugs, yet the heavily marketed brand names are still widely used. And, while a recent Kaiser Family Foundation/ Harvard survey shows most people think insurance companies should use CE to decide what to cover, support declines dramatically with the reminder that CE findings might overrule a doctor’s recommendation.
CE is an important tool to better align the use of health care treatments with what’s known to work. It would probably identify some costly care that could be eliminated without compromising health outcomes. Pursued in concert with other approaches, such as changed provider and patient financial incentives, CE might eventually help us spend less on some health services. But CE’s potential impact is broader than its implications for health spending. It holds promise to help improve the quality of health care delivered, the value we get for the money we spend, and ultimately, our health.
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2 Responses to “We Need Long-Term Strategies”
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CE & curbing unnecessary procedures may effect decreases in costs–$$$ not likely to filter down to employer/patient from insurers & the private health businesses, whose main motive is growth & profit. Real cost containment will come only from a single payer system, in which the middlemen who add nothing of value (think paperwork/bureaucracy)are eliminated. Our nation’s 24 year experiment with medicine as business has failed,like Wall St & the banks, due to greed & lack of regulation.
It astonishes me that in posts pertaining to cost control and quality/access, there is little mention of one of the most obvious problems we face in our health care juggernaut–UNDERSUPPLY OF MEDICAL PROFESSIONALS AND MEDICAL FACILITIES.
With, not only a growing population overall but a mass of baby boomers getting older and older each year, that we have FEWER hospitals, FEWER clinics, and FEWER private medical practices means–quite logically–that prices for medical services (price being THE most efficient rationing mechanism) have risen faster than prices on other goods and services.
Managed care and the allowance of near monopolies to control the individual insurance market (just so that we can say we have an individual insurance “market”) are just BAND AIDS. The reaction by medical providers to managed care and to monopoly insurers–who are joining together in ever larger medical groups–is also a BAND AID. Likewise, proposals to have the government exercise near monopoly pricing power over the market in medical services would also be just another BAND AID.
Our society should be discovering the reasons that so few of our young people are considering careers in medicine and the reasons that so few of our entrepreneurs are opting to invest in medical ventures. Despite the obvious shift in the supply curve in favor of medical suppliers, there is no great flood of medical providers or entrepreneurs being enticed into medicine. Instead, supplies continue to shrink.
I am not advocating that markets should necessarily provide even a majority of healthcare in this country. However, whatever is impeding healthy markets (not these diseased, near-monopoly markets in which medicine is practiced today) surely must be PART of the problem that we face in our healthcare mess.
Therefore, I advocate thinking much LONGER terms that this blogger has proposed. What Mulkey proposes is yet another Band Aid. It’s probably a good Band Aid, and we may need to apply a lot more Band Aids before we make it through this mess, but WE SHOULDN’T DECEIVE OURSELVES INTO THINKING THAT BAND AIDS ARE THE REAL SOLUTIONS TO WHAT AILS OUR HEALTHCARE SYSTEM.