If the recent contretemps in the mass media and blog-o-sphere about provider quality measures, patient responsibility and cost issues are any indication, a lot of folks are thinking hard and talking loud about these issues.
Here’s a synopsis of some of the more trenchant observations.
Medrants has two entries by a treating physician (smart, world-wise, and a bit world-weary), both of which I agree with whole-heartedly. The net – individuals are free to do what they want; just don’t expect me to pay for it.
Note – this harkens back to a debate here on motorcycle helment usage.
Medpundit quotes John Banzhaf, the long-time veteran of the tobacco wars, who is calling for legal action against docs who don’t encourage smokers to quit. That’s a bit extreme for my tastes…
A recent post on patient responsibility and the WV program generated some angry retorts as well. The point these folk seem to be making is that it is very hard to define, much less measure, quality. Another point appears to be that you can’t put a price tag on health.
This last comment is naive, and ignores the fact that dollars spent on health care are not spent on education, space travel, or Nintendo machines. The fact is the “cost” of health care is spent on physician incomes and lifestyles, profits for drug manufacturers and their investors, real estate developers who build skilled nursing facilities, consultants, device manufacturers, and all the “downstream” players – the car dealer that sells the orthopod the car, the travel agency that books her trip, the college that her kids attend.
We as a society choose to spend money that way. And the statistics certainly indicate that don’t get much for our money, especially compared to other countries with better outcomes for less expenditure.
Re outcomes and measurements – don’t confuse “it’s hard” with “it can’t be done”. Anyone with any experience in health care knows case mix adjustment is an art not a science. As they also know that physician practice patterns are more subjective than objective.
That does not mean assessing quality can’t be done. We aren’t there yet, but we’re getting closer. Here’s one example. A client has analyzed their patients with back pain to assess the efficacy of Epidural steriod injections. They found that patients receiving three or more followed by surgery had outcomes that were worse (defined as longer return to work duration, fewer actually returned to work, higher costs) than those that had two ESIs and then surgery.
Is this the end all and be all? Of course not. But it did enable the managed care firm to identify those physicians using the latter treatment plan, and they are now receiving more patients.
Their work, and the work of CIGNA and Aetna, along with states publishing outcomes data for hospitals and Medicare for docs and Dartmouth for geographic areas will all contribute. The winners will be the health companies who figure out how best to use that information, and present it in a usable way.
As to Spike’s question – the sooner the present ill-fated consumer-directed nonsense blows up, the sooner we’ll get to a more rational health care system.
“Another point appears to be that you can’t put a price tag on health.”
I think you misunderstood the posts. In fact, I don’t believe you even read posts which don’t have MD in the signature or that don’t agree with you.
I don’t see anybody talking about putting price tags on health nor did I find this in other posts. I was talking about two things 1) it is not clear that measures in West Virginia plan are cost-saving 2) some provisions of West Virginia’s plan are imposing potentially harmful interventions on people (and not even cost-saving measures) without allowing people to make informed decisions about benefits and risks. Another poster talked about people with mental problem. Where is there pricetag on health?
Diora – first, I do read as many comments as possible. You can go thru many of the older posts and comment threads to gain a better understanding of the interaction here.
Second, you missed the relevant post. It was in response to a comment by Marc on my December 5 post.
Third, while I read as many comments as possible, I just don’t have the time nor is it appropriate to respond to each one. Your original post made some good points. One of the issues with hosting a blog is you need to let the audience engage without too much intervention; I choose to respond to comments when I have the time and the inclination to do so.
Thanks for contributing.
Joe,
Your last comment is what I don’t like… What is a “rational health care system”?
I’m thinking rational – as in rationing, rationalized, socialized…. Etc…
Note also this week’s study in JAMA (http://jama.ama-assn.org/cgi/content/abstract/296/22/2694)
suggesting that the relationship between quality (as defined by Hospital Compare quality measures) and mortality is limited. Disappointing.
“This last comment is naive… the “cost” of health care is spent on physician incomes and lifestyles, profits for drug manufacturers and their investors, real estate developers” etc.
This statement is grossly misleading and nonsensical.
This is equivalent to saying that “the cost” of education is spent on teachers income, construction, food vendors, shoe salesman, book binders…the list goes on.
what’s the point?
All I see on this blog is a quest for socialized medicine. Ask any of us that live in Tennesee what a disaster Tenncare was, and why we all need to stay away from it.
Your comment about the “cost” of health care is spent on physician incomes and lifestyles, profits for drug manufacturers and their investors, real estate developers” etc.. just does not make sense to me. Why don’t we just limit everyone’s income then? Oh wait, that would lead to communism. Is that what every one wants?
Brian – perhaps you need to read a little more and a little more deeply. First, what, exactly is “socialized medicine”? Next, there are over 700 posts on this blog, none of which call for socialized medicine per se. Third, there is nothing here about limiting income. Read the other posts about the problems with fee schedules and the like. Fourth, my point in the sentence you paraphrase is that health care costs flow downstream, and there are few constraints on them, and society has chosen to spend money this way, and this decision means society has chosen to NOT spend this money on other things.
I would encourage you to get beyond your use of misleading labels. It does not help the dialogue.