No End Insight
Excuse the pun, but these days, everyone seems to have the answer to the healthcare problem. Since I’m writing from Washington, let’s start with politics. HHS secretary Leavitt beamed with pride as “over 100 companies committed” to his four goals to “improve quality and reduce costs.” Who could oppose such a move! His boss agreed that Medicare, the VA, and the FEHB (health insurance program for federal employees) would join the fray. And do what? Well, the four goals are:
1. Standards for connecting health information technology, a.k.a. interconnectivity. The goal is to have one electronic medical record system able to read information from another such system. Easy to conjure scenarios where this might be useful, maybe, but the average consumer gives this a big yawn. The hidden agenda here is to enable the feds to mine data from non-federal healthcare systems. “Let’s see who’s doing abortions in Kansas today.”
2. Quality of Care reporting. The idea here is twofold--inform consumers about who is doing a good job in their area (informed choice), and induce providers to conform to national standards RE what constitutes “good care.” One problem is that the goals are set by academics and have little to do with consumer interests. For example, getting to see a doctor within 30 minutes at an ER visit is not on anybody’s list of National Goals, but it’s on every consumer’s list. The second problem is that it’s not clear that these “goals” actually save money. Some are on good footing--giving antibiotics within one our of surgery cut time reduces infections. A lot of drugs are wasted (infections are unusual anyway), but the effort probably nets out on the positive side. Patients, I suspect, would be appalled to learn that not absolutely everyone does this. Most of the other standards have some demonstrated benefit to patient care, but the economic value was not on the table when these measures were considered.
3. Providing costs of services in advance, again seeking to empower consumers. Ambulatory surgery centers do this every day, but hospitals generally have no idea what a given service actually costs. Their accounting systems aren’t set up that way. Probably a non-starter in our lifetime.
4. Incentives for quality care. This is the “Pay-for-Performance” system that has such an apple pie ring to it. Problem is that “performance” is defined by the same measures as in #2, above. Also, the pay differential has been trivial so far. It’s still possible to thumb your nose at the system and still make a living.
Now, about Iran . . . .
