At Last
Someone is beginning to talk about reducing U.S. Healthcare expenditures in a way that brings efficiency to the table. Most of the ideas are . . . well, wrong, but at least there’s a conversation. In a recent Commonwealth Fund report, Karen Davis talks about options to slow the growth of expenditures. If you look at total expenses, there are only two factors: amount of care used and cost of care episodes. Many economists glom onto “unnecessary care” as a convenient target, but that borders on paternalism and brings up the question of who decides? Do we want someone in Washington deciding that you don’t need your gall bladder out or your hernia repaired? Would you tolerate an 800 number voice advising you to take two aspirin instead of going to the doctor?
Another option is enhanced healthcare literacy, so patients could make those decisions themselves. Along with literacy goes the availability of information to make informed choices about whether to have that operation and where to go for it. Paying more out of pocket heightens consumer interest.
The flip side is preventive care. Many worry that patients will forgo immunizations or surveillance exams if they had to pay for them. One proposal is to shift those cost to the insurers by exempting payment from deductibles. Another idea is to shift responsibility for the public’s health (as opposed to healthcare) to public health departments. Flu shots and mammograms would then be provided by your local health department.
Other ideas in the above report include:
1. Increase the effectiveness of markets by promoting competition and improving information (to consumers) on costs. Amen to that.
2. Increase competition in the insurance industry and reduce overhead. This speaks against those who want a single payer. Competition requires multiple players.
3. Payment incentives to promote efficient care. Companies today have no incentive to shop for best healthcare service prices for their employees. They shop for insurance coverage. There are complicated reasons why insurance carriers don’t do this either.
4. Promote patient-centered primary care. Not clear how that would reduce cost, but I’m listening.
5. Technology. The magic bullet. Helpful, yes, but not the primary answer. Providers may use technology to improve their efficiency when pressed by price conscious consumers, but not until then.
6. Improve access, affordability, and equity. Improving access will increase expenditure and do nothing for the cost of individual services. Motherhood ideas, but irrelevant to the theme of reducing healthcare expenses in the U.S.
But it’s a beginning. We’ll water it and see if it grows.
Another option is enhanced healthcare literacy, so patients could make those decisions themselves. Along with literacy goes the availability of information to make informed choices about whether to have that operation and where to go for it. Paying more out of pocket heightens consumer interest.
The flip side is preventive care. Many worry that patients will forgo immunizations or surveillance exams if they had to pay for them. One proposal is to shift those cost to the insurers by exempting payment from deductibles. Another idea is to shift responsibility for the public’s health (as opposed to healthcare) to public health departments. Flu shots and mammograms would then be provided by your local health department.
Other ideas in the above report include:
1. Increase the effectiveness of markets by promoting competition and improving information (to consumers) on costs. Amen to that.
2. Increase competition in the insurance industry and reduce overhead. This speaks against those who want a single payer. Competition requires multiple players.
3. Payment incentives to promote efficient care. Companies today have no incentive to shop for best healthcare service prices for their employees. They shop for insurance coverage. There are complicated reasons why insurance carriers don’t do this either.
4. Promote patient-centered primary care. Not clear how that would reduce cost, but I’m listening.
5. Technology. The magic bullet. Helpful, yes, but not the primary answer. Providers may use technology to improve their efficiency when pressed by price conscious consumers, but not until then.
6. Improve access, affordability, and equity. Improving access will increase expenditure and do nothing for the cost of individual services. Motherhood ideas, but irrelevant to the theme of reducing healthcare expenses in the U.S.
But it’s a beginning. We’ll water it and see if it grows.
