tag:blogger.com,1999:blog-32053362.post32445653265947531..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: Demand drives supply which drives costPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-32053362.post-7007906020196052312013-07-17T16:41:06.087-04:002013-07-17T16:41:06.087-04:00Paul, individual lifespans may be affected by the ...Paul, individual lifespans may be affected by the factors you describe, but population lifespans over time have more to do with public health, nutrition and medicine, and have long been used to assess the general health of a country. Comparatively, we do not show up well. To return to your original point, it may be that demand is driving cost, but if the demand is for non-health improving, but comfort-improving features (Viagra, total joints, etc.) and results in neglect of the former, then one may well ask where our health care dollars should be spent.<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-17594841525612951972013-07-17T15:14:28.807-04:002013-07-17T15:14:28.807-04:00Paul –
I pretty much agree with your list of cost...Paul –<br /><br />I pretty much agree with your list of cost drivers. However, one big one that you didn’t mention is that prices per service, test, procedure and brand name drug as well as devices are typically much higher in the U.S. than in other developed countries. Uwe Reinhardt and others wrote about this in a famous 2003 Health Affairs article titled “It’s the Prices, Stupid.” Regarding utilization, I’ve read that average hospital length of stay in the U.S. is actually shorter than elsewhere and the number of physician consults per capita is also lower than in other OECD countries. <br /><br />We need to find ways to create more countervailing power against high prices charged by hospitals and drug companies. Tiered and narrow network insurance products are good approaches. So is reference pricing which is starting to be used selectively by certain large groups like CALPERS for procedures like colonoscopies, CT and MRI scans and hip and knee replacement. <br /><br />Recent research by insurers in preparation for structuring insurance products to be offered on the new exchanges finds that most people are more than willing to give up some provider choice in exchange for significantly lower insurance premiums. Employers resisted this approach in the past because they perceived that employees wouldn’t like it, wouldn’t understand it or both. That attitude and perception seems to be changing which is a good thing I think.<br />Barry Carolnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-12958912125844380702013-07-17T09:29:17.340-04:002013-07-17T09:29:17.340-04:00Lots of apples and oranges. Lifespan has little t...Lots of apples and oranges. Lifespan has little to do with hospitalization and acute care. It has to do with diet and exercise (not to mention genetics). Exercise, in turn, is greatly dependent on the design of cities and whether commuting occurs by car versus bicycle, foot, and transit.<br /><br />If you wanted to compare acute care outcomes, that might be interesting. In some countries, the stuff we take for granted, in terms of advanced care, is rationed "over there." The UK NICE committee, for example, decides what tertiary and quaternary procedures should be made available--and until what age. Over a certain age, and you can't get a kidney transplant. Here, virtually forever.<br /><br />We pay more for that. Is it worth it? That's a political decision each country makes.<br /><br />Where they all do much better than the US is primary care. We could hypothesize that this makes a difference. In the US, we ration primary care--by income level. How cruel.<br /><br />Also, neonatal care and post-natal care for the babies and small children is surely better in many countries. That surely is cost-effective, but we just don't seem to value children as much as they do.Paul Levyhttps://www.blogger.com/profile/17065446378970179507noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-22611608823754117712013-07-17T09:19:51.997-04:002013-07-17T09:19:51.997-04:00But Paul, they are 'catching up' from ahea...But Paul, they are 'catching up' from ahead - i.e., their citizens already spend less for care and have better lifespan statistics than Americans. True, that costs are increasing everywhere, but you have to see if the outcome curves are converging or diverging.<br /><br />I never was any good at math, so let me know if my logic is illogical.<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-2712582225537408482013-07-16T22:36:01.771-04:002013-07-16T22:36:01.771-04:00Hi Paul, This is perhaps the most concise yet comp...Hi Paul, This is perhaps the most concise yet comprehensive distillation of all the problems that anyone with their eyes wide open the past ten years would agree on (which, admittedly, seems to be the minority of us). As you mentioned, the political will to limit choices or benefits for Medicare enrollees is just not there (to more or less extent on either side of the aisle), and will not be until cost pressures really take us to the edge of sustainability (and perhaps beyond). One hopes that a convergence of pressures (or problem, policy and political streams a la Kingdon) will eventually lead to a solution on at least a few of these fronts, but as you state, we can't rely on such a solution alone. I really believe that there will have to be a paradigm shift in the delivery of care away from the current structure of medicine beyond the old arguments of capitation vs fee for service or hospital vs outpatient. As someone with a background in both health services research and basic sciences, I cant help but see genomics as a change in the entire medical paradigm, or what Christensen refers to as an innovative disruption. I know this has already been touted in both the Innovators Prescription and the Creative Destruction of Medicine (Topal), but I am involved in that arena, and I can tell you that while the progress in the next 10 years will be mind boggling, the practical applications within 25- 30 years from now (and for baby boomers and younger this is our lifetime) at the very latest will fundamentally alter medical practice. Until then I fear we will make tweaks here and there to keep the system chugging along against overwhelming interest group pressures from every corner of the spectrum.<br />Abid.akhan13https://www.blogger.com/profile/10927411317773253949noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-63153933030707558472013-07-16T22:12:14.445-04:002013-07-16T22:12:14.445-04:00True that we are twice as "efficient" in...True that we are twice as "efficient" in diverting money from the rest of the economy when compared to other developed nations, but they are gradually catching up. The same forces are at work there, but their legislatures have limited the amount going into health care by statute. Public pressure is pushing up the percentage of GDP that goes to health care in those countries. They also don't count other "costs" like free tuition for doctors and nurses.Paul Levyhttps://www.blogger.com/profile/17065446378970179507noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-47384121951381395762013-07-16T19:09:42.969-04:002013-07-16T19:09:42.969-04:00Welcome back.
I don't think it's just homo...Welcome back.<br />I don't think it's just homo sapiens, but American homo sapiens. See link below, in which the pertinent quote is:<br />“The United States spends more than the rest of the world on health care and leads the world in the quality and quantity of its health research, but that doesn’t add up to better health outcomes,”<br /><br />http://www.washingtonpost.com/national/health-science/us-life-expectancy-on-rise-but-progress-lags-global-peers/2013/07/10/dff836c4-e8c3-11e2-aa9f-c03a72e2d342_story.html<br /><br />nonlocalAnonymousnoreply@blogger.com