A Painless Way To Hold Down Health Costs?
quality, cost and/or access
- This article is posted in:
Quality of Care--How Good Is Good Enough? Harold C. Sox; Sheldon Greenfield JAMA. 2010;303(23):2403-2404 (doi:10.1001/jama.2010.810 [Extract]:
The quality improvement movement has changed its focus from improving the health of patients to obtaining the greatest return for the investment. Why? Because experience has shown, time and again that the former is beyond our abilities, beyond any 'carrot and stick' approach to patient care, and beyond any contrived incentive realignments. When it comes to lifestyle management, we fail, miserably. For instance, getting people to stop smoking, the only thing that has worked is raising the pric
Specialists fractionalize care; that's costly; In the medical home, primary care treats the whole patient. To explain the drastic shift needed to encourage primary care and discourage a further and unjustified overabundance of specialists, know that: 35% of visits for circulatory conditions are to family physicians, 27% of visits for musculoskeletal problems are to family physicians
Much of the work on health disparities and inequities in access focuses on comparisons between the insured and those without coverage; the uninsured come out wanting. [Surprise] “Uninsurance is associated with mortality.” Uninsured persons have less access to services and suffer worse health outcomes than those insured. Breast Cancer patients suffer with a 30-50% higher mortality rate Accident victims have a 37% greater mortality rate (1)
If you are in a concierge medical practice or you are a specialist, you can stop reading. But, if you aren't and are concerned about the pressure to reduce the costs of care while not compromising accessibility or the quality of care, then understand the incentives matter critically to you; ignore that and you will pay dearly. Perhaps you feel how the insurers pay you is what it is and you'll deal with it.
The question really is what are you getting for your health care dollar? What's right or not right with the healthcare system, and why? And, what specifically needs to be changed and how will that be accomplished, if at all? The "Bang for the buck" issue, the Medical Loss Ratio, is revisited in "Healthcare Reform Will Fail if We Don’t Reduce Costs!"
Clearly spending reform is not only part and parcel to "affordable insurance but also as the preeminent long-term threat to the economy and the competitiveness of American business." The article referenced below discusses policy options and various approaches to cost containment. 1) Bundled Payments as in episodes of care, 2) all-payer hospital rate setting, 3) Disease state management programs, 4) Infrastructure-related options that form the foundation for other efforts or options. Included
When patients require specific therapies and an insurance company makes the frail or sickly patients jump thru hoops, denying or delaying care, it's time to move away from the insurance model. How furious should we be when the insurer uses technicalities to refuse coverage, makes patients wait incessantly on the phone, transfers calls to G_d knows now many departments and then, after seemingly hours, the connection breaks, etc.?
Considerable “havoc may be wrought by untrammeled overtesting” but it is “perceived underdiagnosis that arouses legal and moral wrath." In many respects, well-intentioned preventive medicine may, quite frequently, reveal things that may not benefit from early intervention, and worse, can make patients fret unnecessarily or have surgery that sets them back. Dr.