Pay More, Get Less – The Certain Future Of Healthcare
Even with healthcare reform, Americans will increasingly be burdened with high deductibles, more financial responsibility, and less satisfaction with their health insurance for the foreseeable future. Why? Because the healthcare system is unable to transform its services in a manner that other industries have done to improve quality and service while decreasing costs. The two biggest culprits are the mentality of healthcare providers and the fee for service reimbursement system.
Doctors and patients haven’t altered the way they communicate over the past hundred years. Except for the invention of the telephone, an office visit is unchanged. A doctor and patient converse as the physician scribbles notes in a paper chart. Despite the innovations of cell phones, laptop computers, and other time saving devices, patients still get care through face to face contact even though banking, travel, and business collaboration can be done via the internet, webcams, and sharing of documentation. As Dr. Pauline Chen noted in a recent article, doctors are not willing to use technology to collaborate and to deliver medical care better, more quickly and efficiently. Mostly it is due to culture resistant to change. Partly it is due to lack of reimbursement. Both are unlikely to be addressed or fixed anytime soon.
Yet, patients come to doctors for our medical expertise and insight in order to stay well or get better. They don’t care if it is done via the web or in person. If doctors think their problems are safe to handle via technology then they are for it. If doctors feel a particular condition must be handled in the office, then they are willing to do it. After all, aren’t we the ones who can make that assessment? They trust us to make the right determination. We must be willing to challenge tradition and training in the face of a rapidly evolving world.
If this country is going to make healthcare more affordable and more accessible, then doctors need to collaborate better. Only doctors can stop the increasing march of medical expenses.
If we as a profession are unwilling to use technology to get the information and expertise at the point of care to get people better sooner, then our country has only two options left to make healthcare affordable. The first is the government to force pricing down as it is done in other countries. Based on the agenda of Medicare, the government is already squeezing costs by dictating pricing which may not be realistic. The second is to force patients to try and figure out which tests, procedures, doctors are best to help them. Research shows they don’t want that responsibility and when they do have that burden they skip care. Nevertheless, employers are increasingly moving their employees to less comprehensive consumer driven health plans (CDHP) and high deductible health plans (HDHP) to save money.
It’s doctors who aren’t willing to do virtual visits. The public is ready and waiting. If we as a profession won’t consider using the same technology we use to communicate with family and friends as well as use these very same tools to provide “second opinions” to our loved ones who value our medical expertise to our patients, then how can we say that we are committed to making healthcare accessible and affordable to all Americans?
While there is a small group of enthusiastic entrepreneurial doctors and leading edge healthcare organizations trying to move American medicine into the 21st century, the healthcare system really needs Steve Jobs and Apple to transform healthcare. As it currently exists, the majority of doctors are either unwilling or unable to make the change.
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
While I agree that doctors could very well use alternate communication technologies to deliver services to their patients to lower costs, I am not convinced that this is really the reason why US citizens spend 17% of GDP on health care. I am also not convinced that fee for service is driving the costs so high either. Many other first world countries spend roughly 10% of GDP on health care and use fee for service approaches while still delivering excellent care.
That said, I do not know why the US spends so much on health care aside from the possibility of unnecessary tests and procedures. If health care reform is to succeed in preventing cost increases however, identifying the reasons for these cost increases will be of utmost importance.
It’s the payment system and stupid regulatory environment (meaning HIPAA). A surprising number of us are more than willing to pursue virtual encounters only to be told in no uncertain terms that email is a no-no and we cannot collect any payment such encounters.
While other countries may use fee for service, the reality is that doctors are paid a lot less than US doctors. This isn’t to say doctors in the US are overpaid or that doctors in other countries are underpaid, but rather this is just a fact. This coupled with less expensive prescription medications may be why healthcare outside the US is a smaller percentage of GDP.