Cost
Remember, COST is the numerator of the EFFICIENCY equation. The HMO movement reduced costs, but it also changed the denominator--the healthcare services were not the same. Eventually, Americans decided they didn't like gatekeepers, limited options, and third world providers. To care about efficiency, consumers must have a choice. On a micro level, as Mickey states, it's all about what hapens to me. When I walk into an ER, I want to see a doctor . . . NOW; and when able, I will choose an ER that sees me promptly. Some emergency rooms now see patients within 30 minutes (http://www.oakwood.org/Emergency/index.asp). From the institution's viewpoint, there must be motivation to be efficient. Private, for profit institutions are intrinsically more efficient than universities--they have to be. In thinking about this, you must keep the denominator constant--same healthcare service. And you must include the patient's time in the numerator. That's a cost also. Misuse of healthcare (over/under use) is largely a value judgement. If you don't want to pay for the healthcare I want, you will call it overuse. On a macro level, some healthcare use is driven by personal choices--obesity, smoking, inactivity. Population healthcare would be more efficient if we changed individual habits. Demand management. Think broadly about cost--spending money on anti-nausea drugs will reduce the total cost of the patient's recovery room stay. Every $1 spent on sex education classes saves $3 in costs for teen pregnancies. Next time--quality vs efficiency.
Comments
Talk about cost! Today is day one for MPDBP (medicare prescription drug benefit program)or more simply Part D. Is it going to cost? You bet it is! And is it efficient? If you believe that I have a bridge to sell you. We know who will pay, we all will. And what will we get for our money? That's a good question. A better one is where will all that money really go?
If we are going to control medical costs and increase efficiency (better care for more) we must work on the macro level, get political and find a better way. Anything less is a waste.
Posted by: John Williams | November 15, 2005 03:01 PM
can this topic exist without the seemingly unrelated issue of price. seems as though the cost and the price are negotiated separately. an individual with a health savings account and paying for his/her own treatment without the ability to negotiate a "good deal" as a HMO is able to do will pay significantly/ up to 1000% more for the same or similar treatment. with respect to cost, the provider has only to accept a check or cash instead of the dificult/sometime impossible task of collecting from the insurance company. without cynicism the claim can be made that the drug benefit now attached to medicare is only a benifit to the drug provider. get political and ask why we pay so much more for so much less???
Posted by: sam oman | November 20, 2005 08:30 PM