The Texas Medical Center Health Policy Institute recently convened 10 of the country’s leading experts on health care policy to develop recommendations that, collectively, could reduce the cost of health care and cut the more than $1 trillion in annual wasteful health care spending.
Their recommendations are described in a new TMCHPI report: "Reducing the Cost of Health Care: Current Innovations and Future Possibilities."
The eight cost-savings recommendations are
1. Allow the government to use cost and cost-effectiveness in decision-making
2. Eliminate fee-for-service
3. Standardize quality-of-care metrics
4. Empower patients to be responsible for their own health and health care
5. Improve care coordination through task shifting
6. Reduce Emergency Department utilization and readmissions
7. Develop more specific approaches to improving end-of-life care
8. Meaningfully address the impacts of adverse childhood experiences
As a patient and informed consumer of my health care and that of my disabled husband with frontotemporal dementia, some of these recommendations have merit. But #1, "Allow the government to use cost and cost-effectiveness in decision making" definitely does not. It could lead to health care rationing and decisions about who is "worthy" of health care. It could also lead to arbitrary decisions about what cost-effectiveness means. It may sound great to disallow reimbursement for treatments that have only a low possibility of success (say 10 or 15%) in the abstract, unless *you* are the patient being denied the possibility of being part of the 10 or 15% for which the treatment succeeds. It would also create a world where only the wealthiest among us have a chance to receive treatments with a low possibility of success. I sure don't want that; anyone who desires a no compassionate society should. If you're talking about Medicare or a universal health care system, raise premiums to provide top-notch health care for everyone on a sliding scale by income. I'd be thrilled to pay more. For Medicaid, alocate more money to the program.
ReplyDeleteSue McKeown
Gahanna, OH
Every healthcare system rations in some way. Techniques include "ability to pay", cultural norms and pressure, considering cost and cost effectiveness, by limiting supply. Most do it by some combination of these techniques -- but all do it somehow because a society can't spend 100% of its resources on healthcare (people would starve because no resources were devoted to farming).
DeleteYou might want to look up NICE in the UK which uses QALY (Quality Adjusted Life Years) as a way to determine which treatments are approved and which are not based on science and statistical data. A few years ago (there have been changes since then in exchange rates and in NICE's guidelines but I've not been tracking them), if a treatment cost more than $50,000 and statistically added less than one QALY, it was generally not approved. This seems like a reasonable ballpark for such determinations.
When a government provides a service, the government sets the rules for how and when to provide that service.
DeleteFor example, when the government provides security in the form of police, the government decides what level of security to provide and what level of resources to allocate to particular situations. Generally statistics are used to determine how and if resources should be deployed. The goal is not to prevent 100% of crime or even to prevent all murders - it is to reduce them to an acceptable rate in the eyes of voters and taxpayers. Police don't typically provide full time body guards to individuals, but everyone is free to hire their own bodyguards (or even a small army) to protect themselves.
Fortunately, in a democracy, the voters have indirect control over things like speed limits and police staffing levels.
Government provided healthcare is no different, nor should it be, than other government provided services. Such services are provided primarily for the common good, not the individual good. This is appropriate since everyone is forced to pay for them regardless of if they use the service or want the service, or even have a religious objection to the service (such as some do to abortion).
To the extent that someone fears death (perhaps for religious reasons and fear of how their deity will judge them), it's understandable that they may want likely futile medical care to extend their life by a few more weeks or months even if in a highly demeaned state. However, many (probably esp. atheists such as myself) don't want that for themselves and don't care to pay for it for others. As well, many of us believe money is best spent on preventative care and healthy living initiatives rather than spending hundreds of thousands of dollars a month for treatment of someone whose statistically adjusted lifespan is only expected to be a few weeks or months.
Most specifically, given the separation of church and state in the United States, taxpayers certainly should only pay for care that is medically appropriate (cost effective and medically effective given statistical data) and NOT for any care that is primarily motivated by religious beliefs in "life at any price".
BTW, Medicaid and Medicare both regularly provide services that have only a 10% chance of "success" (saving the patient's life and returning them to approximately the state they were in before the condition or illness that is being treated struck them) to life threatening conditions.