Goals and Strategies
Attention is turning again to “healthcare reform,” whatever that means. One note of caution in thinking about systems of care and payment: declare your goals up front, then develop a strategy to achieve those goals. If your goal to reduce the total amount of money spent on healthcare in the US, buying insurance for the 46 million currently uninsured is NOT the answer. More insurance leads to higher utilization, thus raising the total expenses.
Here’s an article that has been on my desk for awhile: Calvin Pierson wrote a piece in the Washington Post titled, “How to Trim Health Costs in Maryland.” Virtually all of the article was devoted to providing health insurance to the uninsured in MD, and this would, of course, increase Health Costs. The bill would be paid by MD taxpayers, US taxpayers, business owners, and smokers. Mr. Peirson is the president of the MD Hospital Assn., and I’ll let you guess who would benefit from his suggestions.
Providing healthcare to the uninsured is a different goal. Any strategy here ought to be budget neutral. Buying more health insurance policies is counter-productive, regardless of who you tax to pay for it. Yes, raising cigarette taxes is a good idea. Same for gas tax. But not to throw more money into the healthcare system. This is too complex a problem to be solved in a sound bite, but there are ideas that might work: Demand management works. (In healthcare, it’s called “disease management,” and Mr. Pierson did mention this.) Prevention works, but the lead time is long. Bribes and coercion work. In France, women are paid to make prenatal visits. MA has a law that everyone must buy health insurance.
In most cases, the uninsured are already getting healthcare, and those with insurance are paying for it thru cost shifting--charge more for those with money to pay for those without. The rest of the money is already in the system, just waiting for us to apply it to the uninsured. It’s there in the form of waste, and the way to recoup those funds is thru improved efficiency.
Let’s make efficiency a goal, and develop strategies for success. Stay tuned.
Here’s an article that has been on my desk for awhile: Calvin Pierson wrote a piece in the Washington Post titled, “How to Trim Health Costs in Maryland.” Virtually all of the article was devoted to providing health insurance to the uninsured in MD, and this would, of course, increase Health Costs. The bill would be paid by MD taxpayers, US taxpayers, business owners, and smokers. Mr. Peirson is the president of the MD Hospital Assn., and I’ll let you guess who would benefit from his suggestions.
Providing healthcare to the uninsured is a different goal. Any strategy here ought to be budget neutral. Buying more health insurance policies is counter-productive, regardless of who you tax to pay for it. Yes, raising cigarette taxes is a good idea. Same for gas tax. But not to throw more money into the healthcare system. This is too complex a problem to be solved in a sound bite, but there are ideas that might work: Demand management works. (In healthcare, it’s called “disease management,” and Mr. Pierson did mention this.) Prevention works, but the lead time is long. Bribes and coercion work. In France, women are paid to make prenatal visits. MA has a law that everyone must buy health insurance.
In most cases, the uninsured are already getting healthcare, and those with insurance are paying for it thru cost shifting--charge more for those with money to pay for those without. The rest of the money is already in the system, just waiting for us to apply it to the uninsured. It’s there in the form of waste, and the way to recoup those funds is thru improved efficiency.
Let’s make efficiency a goal, and develop strategies for success. Stay tuned.
