(Note: After a five month absence from posting comments, I offer this observation, with more to come. There’s much to do.)
The message resonating from the Wall Street protesters is that income inequality doesn’t work. And among the developed nations, theUS is the most unequal. This distinction does not come without cost. The greatest, of course, is the social cost borne by those who are poor. But what the protesters may not fully realize is that another is the high costs of health care. This is because the costs of caring for the poor are much greater. And together with the rising numbers of poor patients, they are crushing the health care system.
This notion may seem shocking, since it is generally believed that low-income patients receive less health care. After all, many have little or no health insurance, and most have poor access to primary care. Isn’t it the wealthy whose access is best and who use the most? The answer is Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
I have opposed Medicare’s use of claims data to evaluate the quality of medical care. Quality medical care is the goal that must be achieved. However, no one has described the measurement of quality medical care adequately.
Physicians recognize when other physicians are not performing quality medical care. Physicians recognize when another physician is just testing and performing procedures to increase revenue.
These over testing physicians are a small minority of physicians in practice.
Quality medical care is not about doing quarterly HbA1c’s on patients with Diabetes Mellitus. Quality medical care is about helping patients control their blood sugars so their HbA1c becomes normalized. It is about the clinical and financial results of treatment.
The clinical and financial results depend on both patients and physicians. Patients must be responsible for Read more »
*This blog post was originally published at Repairing the Healthcare System*
A recurring theme of the CRB is that the rising cost of healthcare is the main internal threat to the continued viability of the US. Indeed, the very title of this blog reflects the chief mechanism which is being employed, fruitlessly and disastrously, in the attempt to reduce those costs.
Recently, DrRich pointed out that there are four ways – and only four ways – to reduce the cost of healthcare. He did this as a service to his readers, so that when politicians describe in their weaselly language how they will get the cost of healthcare under control, you will be able to figure out which of the four methods they are actually talking about.
While DrRich’s synthesis has been generally well-received, a few readers did offer one particular objection. DrRich, they assert, left out a fifth way to reduce the cost of healthcare, and the very best way at that. Namely, just get rid of the waste and inefficiency.
DrRich has talked about this before, but obviously it is time to revisit the issue.
It is, in fact, a central assumption of any healthcare reform plan ever proposed that we can get our spending under control simply by eliminating – or at least substantially reducing – the vast amount of waste and inefficiency in the healthcare system. Conservatives propose to do this by Read more »
*This blog post was originally published at The Covert Rationing Blog*
Recently the NEJM ran a Sounding Board piece on Bending the Cost Curve in Cancer Care. The author’s take on this problem:
Annual direct costs for cancer care are projected to rise — from $104 billion in 2006 to over $173 billion in 2020 and beyond.2…Medical oncologists directly or indirectly control or influence the majority of cancer care costs, including the use and choice of drugs, the types of supportive care, the frequency of imaging, and the number and extent of hospitalizations…
The article responds, in part, to Dr. Howard Brody’s 2010 proposal that each medical specialty society find five ways to reduce waste in health care. The authors, from the Divisions of Hematology-Oncology and Palliative Care at Virginia Commonwealth University in Richmond VA, offer two lists:
Suggested Changes in Oncologists’ Behavior (from the paper, verbatim — Table 1): Read more »
*This blog post was originally published at Medical Lessons*
Last week, I was honored to learn that the ACP Advocate blog was selected by voters in a national competition as the Best Health Policy/Ethics blog of 2009. Yesterday, ACP issued a news release announcing the award, in which I am quoted as saying that the blog “seeks to inform and entertain readers and to elicit thoughtful commentary from across the political spectrum, not just from ACP members but from others with an interest in health policy.”
Awards and recognition are nice, but what I enjoy most is making readers aware of interesting ideas, studies, and commentary that otherwise might not have come to your attention. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*