Slowing the Growth of Health Care Costs — Learning from International Experience (New Eng Jour Med)

[pinto]

http://content.nejm.org/cgi/content/full/359/17/1751?query=TOC

Slowing the Growth of Health Care Costs — Learning from International Experience
Karen Davis, Ph.D.

High health care expenditures and the growing number of people without health insurance set the United States apart from all other industrialized countries. The United States spends twice per capita what other major industrialized countries spend on health care1,2 but is the only one that fails to provide near-universal health insurance coverage. We also fail to achieve health outcomes as good, or value for health spending as high, as what is achieved in other countries.

The United States has been slow to learn from countries that have systematically adopted policies that curtail spending and enhance value. Chief among these are mechanisms for assessing the comparative cost-effectiveness of drugs, devices, diagnostic tests, and treatment procedures; implementation of information technology, including electronic repositories of patient medical information, across sites of care; easy access to primary care, including organized systems of off-hours care; a strong role for government in negotiating payment for care; and payment systems that reward preventive care, management of chronic conditions, care coordination, and health outcomes rather than volume of services.

<snip>

The issue, therefore, is not so much whether we know how to slow down the escalation of health care costs. Abundant international evidence, and even examples in the United States, demonstrate that higher quality, better access, and lower costs can be achieved simultaneously. Rather, the United States has been paralyzed by partisan divisions at the level of the federal government and by organized opposition from those who benefit from the status quo. The key to progress may lie in both a presidential administration committed to transformation of the health care system and a new policy process that is better insulated from special-interest political pressures. At a recent summit sponsored by the Senate Finance Committee, both Chairman Max Baucus and Federal Reserve Board Chairman Ben Bernanke raised the possibility of a "Health Fed" or a "MedPAC with teeth," which would be delegated by Congress to make specific payment and policy decisions under a broad policy framework established by Congress. This approach, applied first to Medicare, could accelerate the diffusion of policy innovations throughout the country and provide a testing ground for broader application to Medicaid and commercial insurers.

The status quo is unacceptable. Without serious commitment to change, health spending as a percentage of the gross domestic product will rise from 16% currently to 20% by 2017; and Americans without adequate insurance and access to essential services will continue to suffer avoidable health consequences. American resources and ingenuity are adequate for the challenge. What is required is national leadership and commitment to moving toward a high-performance health care system.

Source Information
Dr. Davis is the president of the Commonwealth Fund, New York.

References

American College of Physicians. Achieving a high-performance health care system with universal access: what the United States can learn from other countries. Ann Intern Med 2008;148:55-75.

Schoen C, Osborn R, Doty MM, Bishop M, Peugh J, Murukutla N. Toward higher-performance health systems: adults' health care experiences in seven countries, 2007. Health Aff (Millwood) 2007;26:w717-w734.

Nolte E, McKee CM. Measuring the health of nations: updating an earlier analysis. Health Aff (Millwood) 2008;27:58-71.

Schoen C, Guterman S, Shih A, et al. Bending the curve: options for achieving savings and improving value in U.S. health spending. New York: The Commonwealth Fund, 2007.

Orszag PR, Ellis P. Addressing rising health care costs -- a view from the Congressional Budget Office. N Engl J Med 2007;357:1885-1887.


The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved.

http://content.nejm.org/cgi/content/full/359/17/1751?query=TOC

[napi21]

1. There's also a few things that article hints at but doesn't actually say.

Other contries don't bestow the HIGH monetary value on doctors that we in the US do. There's also the high number of unnecessary test that doctors insist on, JUST to be sure they have documentation to protect them against law suits! Then there's the hugh profits collected by our wonderful insurance companies.

How do you change those things? I sure don't know!!!

[drm604]

2. You institute universal single payer health care and kill two birds with one stone.

This would eliminate health care dollars going towards insurance company's profits and it would also help with the law suit problem.

Currently many people who are injured by a medical procedure will sue even if they aren't really sure that the doctor is at fault. They do this because the injury subjects them to a lifetime of medical costs and they feel that they need to sue in order to have the means to bear those costs. With universal health care that won't be an issue since they'll be assured of receiving the care they need. There will still be lawsuits but they'll be punitive and for loss of income only, so on average there will be less paid out.

[dflprincess]

3. If I recall correctly from "Sicko"

Other countries don't let their doctors leave medical school owing tens of thousands of dollars. Doctor's salaries might come down some if they didn't have that kind of debt hanging over their heads. (And I also seem to recall that the European doctors shown in "Sicko" live pretty well.)

[napi21]

5. In the one instance that I know, you're right. A friend's daughter is

attending med school now. She's in her 2nd year & her boyfriend is in his 4th. The deal with them is as long as you achieve a sertain grade avg. the cost is $1,280 per semester (in equivelent USD). Both of them have the grades, so I don't know what the cost is if you don't reach, I think, a B avg.

They live in Romania, but AFAIK, it's the same or very similar in Italy.

My son lives in Sicily and just married the med student's mother, which is how I learned about this deal.

I don't mean to sound like a defeatist here, but I cannot in my wildest imagination see a way the US could not only adopt universal HC, but PAY FOR COLLEGE TOO!!!! I happen to believe I'm a realist, and I just can't see that happening...certainly not in MY LIFETIME!

[dflprincess]

7. We could do it - but we just won't

Think of what Iraq is costing us every month and imagine where that money could be going. And, while it's not popular to say (but I'm not running for anything) I'd be willing to pay more in taxes if it meant we had the same social safety nets that many European countries have - including an eduated public. Another line from "Sicko" being "Do we want to live in a me society or a we society?"

[pinto]

4. I think reining in the insurance companies comes first. All else follows after that.

The midnight denial in the Republican Congress to allow Medicare to negotiate for bulk pricing on medications, as the Veterans Administration already does, is costing us millions.

I'm not sure we bestow a high monetary value on doctors here - that seems an old canard. Doctors for the most part aren't rich in this country. So, not sure what your point is there.

As far as unnecessary tests go - you always have the blanket right to say no. And get a second opinion.

[napi21]

6. As to how I know there's a BIG difference in Dr. compensation between

the US & Europe, see my post #5.

When I fist heard about that girl attending med school, I guess my reaction on the phone said it all, and my son told me, Drs. there don't make the kind of money they do in the States. They aren't starving for sure, but their avg. salary is in the $50,000-$70,000 catagory after they complete residency and have an established practice.

I disagree with your statement "you can always say no & get a second opinion". I'm not talking about mysterious diseases, I'm talking about standard stuff. ie: About 4-5 years ago I caught a winter cold. I happen to think that most ordinary things you get will run their course and go away, which does usually happen. That time it didn't. I took asprins and used a few boxes of tissues, but after about 3 weeks, the cold wasn't going away. Then I started coughing more and got a feaver and chest congestion that seemed to get worse each day. I decided I guess I better go to the Dr. and get something to get rid of this. I KNEW as I watched the Drs. face as he did the normal listen to your chest, take your BP, etc that he knew what the problems was, but he insisted that I go to an xray facility for and xray. Magically the next day, his asst. called to say "You have pneumonia. Give me the name and phone # of your pharmacy and I'll call in a script." I KNOW he knew while I was in his office that I had pneumonia.

My best friend is the Dir. of Accounting at the largest hospital system in a prominent NE city. When I was complaining to her about this "unnecessary xray" she told me "He had no choice! The company that carries his malpractice insurance insists on those tests, and if he doesn't arrange for them, they'll drop his malpractice coverage!"

THAT IMO is BS! It wouldn'[t have done me any good to say NO to the silly xray because the DR. would simply have said, well then I can't treat you!

[FiveGoodMen]

9. I don't think it's doctors getting all the money.

I think it's hospitals, administrators, insurance companies and their stockholders, etc.

By now, doctors are probably getting pretty well screwed.

[bemildred]

10. I'm surprised MDs allowed themselves to be suckered into this sort of situation.

I mean, I know some select few are making out like bandits, but all the rest are being driven nuts and broke.

[bemildred]

8. Don't forget the high cost of a Medical degree and license.

It all counts.