July 6, 2009

The Ring of Fire

Posted in Health Insurance, Incentives for good Health, Public Private Partnership at 10:27 pm by healthyacrossthenations

There have been a number of studies to investigate the causes and symptoms of the cost issue in the US Health Care System. The New Yorker has a nice article about this issue which highlights the complexity of the problem http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

Even with caps on lawsuits and other ideas mentioned below- there are still problems (see the above article- p7) costs are still high.  As such,  Tort Reform alone will not help correct the causes of medical error and/or patient misinformation that can lead to the causes of suits.

The above article & others in the economist point to the success of places like the Mayo Clinic which create incentives for Doc’s to work together – to spend more time collaboratively reviewing files. This helps minimise potential error by the mere fact that 2-5 medical heads are better than one. The medical profession can be  stressful with having to make so many decisions every day, especially when medical science on living creatures is not exact- people respond differently to treatment and react differently to health situations. The US needs to build a useful evidence based medical database that can help Doc’s review the different things that have worked- and keep up to date on new treatment options- much like they have in the UK with the NICE database &  in other countries as well.

Doc’s at the Mayo Clinic & similar places get a salary and are not paid per service,  removing the incentive for unnecessary tests etc- but adds incentive to increase professionalism.  Attaching additional incentives to improve services would be moving along the right track- See Below.

If Patients have the opportunity to become better educated about Preventive Health Care and their own health issues, they would be better able to help make health decisions with their Doctors.  Preventive health education has been shown in many studies to not only reduce health events, but also to reduce costs of treatment  the world over.This needs to be built into the health system through incentive, much like cutting wait times.  For example, as health education reduces costs in the long run, those clinics that offer Preventive Health Education & services appropriate for their population that then show improvement in patients health should get funding to continue and/or expand upon their Preventive programs- and possibly a clinic wide bonus. Further, if a Health clinic reviews its cases and sees that for whatever reason there is one or more health condition common to the community (could be genetic, environmental, or epidemic)- and then they create a supervised support group that can help the patients adhere to treatment and maintain their health- and the evidence reflects that a majority of them do- then the clinics should be given funds to continue this kind of treatment.

We must make practicing medicine more collaborative and more interactive. Medicine is an exciting field where knowledge can grow every day. R research has shown that medical personnel respond very well when their work environment improves (many times it is more important than raised salary- particularly for nurses). Medical Professionals enjoy learning and applying knowledge (for many it is the reason they got into the field). We should be looking for ways to help them become more proficient at providing quality care.

Like this Economist Article states- we must change the incentives to better fit the outcomes we want. We want lower costs for health care. We want quality care. We want effective care. I do not believe a government run system is the right answer for the US, nor is the status quo.  My concern with pure nationalisation  is that the burden of financing and running such a system will be too much- especially all at once- and that medical professionals will be overwhelmed and begin to tune out at work or worse to leave. Such a system will also be very difficult to manage nationwide at an equal level.

We have a great infrastructure of private players that have fared fairly well (except for cost). We should capitalise on this. I do believe that state insurers should link up to one of five national Health Funds that will be Non Governmental Organisations (Not taxed- they are providing a public service) that should be financed by the government based on a capitation formula for population, age, and certain illnesses. These monies should come through minimal employer and patient contributions, both graduated progressively according to salary and/or income. Further, the Health Funds should be able to offer higher levels of service for additional fees, thus existing as public/private entities.

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