What do you think are the biggest reasons for health care cost increases

[maddythebeagle]

I set it up for you to vote for the 3 that you think are the most significant....this is mostly your opinion from your experience using the health care system and the numerous "studies" posted here.

If you have something else, I can add....some of these might overlap

 

[Khan]

End of life issues (i.e. pumping money into lost causes)

I think this is the elephant in the room.

 

[audreyh1]

I actually think one major reason is the outrageous prices set for drugs. The chemo drugs my MIL takes are outrageously priced, as are drugs for fighting side-effects, etc. 10X+ of the previous generation of drugs. Why were the prices set so high? Because the drug companies figured they could get away with it and are super aggressive about pricing.

Since Medicare pays for a huge percentage of cancer treatment in the country, and Medicare is not allowed to negotiate drug prices per law, this mainly amounts to "robbing" medicare. Medicare directly pays for all cancer drugs by the way - it's not part of a "drug prescription program".

There are "foundations" to help patients with the outrageous drug copays that result. This is kind of like a kickback (a company is NOT allowed to pay the copay of a patient). But these "independent" foundations have funds donated by the drug companies themselves - imagine that!!!

Just do a search on Avastin if you want to learn more about how companies have changed their drug price policies in the past few years.

Audrey

 

[wabmester]

If you have something else, I can add

Please add fat people.   Fat people are hospitalized 3.85 times as often as not-fat people.   Fat people require twice the cost for drugs.

20% of the sickest Americans are responsible for 85% of medical expenses.

End-of-life care is only responsible for 20%.

 

[Zoocat]

Please add fat people.   Fat people are hospitalized 3.85 times as often as not-fat people.   Fat people require twice the cost for drugs.

Would you please cite your sources for this statement? Thanks

 

[TromboneAl]

Here's an important reason:

Insured not paying their bills.

And by that I mean that the way much of health insurance is set up, the person only pays a fraction of the cost. Who's going to comparison shop or make a decision based on cost if he/she doesn't even know how much the treatment costs?

 

[wabmester]

Would you please cite your sources for this statement? Thanks

Health Services Use and Health Care Costs of Obese and Nonobese Individuals
Raebel et al.
Arch Intern Med.2004; 164: 2135-2140.

 

[kz]

I was thinking the same thing, wab, when I read the poll. Obesity is a huge reason for increases in medical care.

 

[Martha]

Interesting choices of options. If you are going to include the "market force" choice, I would include the "lack of price controls" choice.

I would also have added the option of a fragmented delivery and payment systems.

 

[bongo2]

Because of my job I know for a fact that by far the largest share of medical "inflation" is increased medical utilization rather than increased cost for the same treatments. The biggest reason for that is not on your list: many treatments work much better than they did just a few years ago, so more people want to take advantage of them. A related factor is the lack of market feedback.

 

[Martha]

Here is another possible factor:  poor quality care (no offense to dear Rich)

http://www.dlc.org/ndol_ci.cfm?kaid=139&subid=275&contentid=250731

The report identifies the causes of poor-quality health care as underuse, overuse, misuse, and waste of medical services. It estimates that 30 percent of all direct health care outlays today are the result of poor-quality care. A 2004 report by the RAND Corporation reinforces this point, as it finds that American patients receive proper care only 54 percent of the time

 

[Rich_by_the_Bay]

Here is another possible factor:  poor quality care (no offense to dear Rich)

http://www.dlc.org/ndol_ci.cfm?kaid=139&subid=275&contentid=250731

The report identifies the causes of poor-quality health care as underuse, overuse, misuse, and waste of medical services. It estimates that 30 percent of all direct health care outlays today are the result of poor-quality care. A 2004 report by the RAND Corporation reinforces this point, as it finds that American patients receive proper care only 54 percent of the time

Right on target, and no offense taken.

I have spent the academic part of my career in a field called evidence-based medicine which strives to standardize care according to the best evidence when available. It also uses serious decision analysis to help use the evidence most appropriately. It results in better outcomes and about 30% lower charges. But it's a little complicated and its teaching has not met with uniform success. Canada is ahead in that regard -- in fact, I got my initial training and teaching experience in the field at McMaster.

Almost invariably, when you find pockets of care where the recommended approach for a given disease varies widely from doctor to doctor, it is a) more expensive, and b) not "evidence-based" in the formal sense of the term. Not only do we need better science, but we also need better systems to assure that we make the best of the science we already have.

BTW, I'd emphasize a point already made: we do have good and even great treatments and tests available that simply didn't exist 10 years ago. I am sometimes amazed at some of the new technology. But the chaotic market, regulatory, intellectual property and other forces invariably cause new technology prices to the very top edge of what the market will bare.

Sometimes I wonder if the only solution that will tame all this is a "clean slate." The forces at play are very highly entrenched and it is not easy to just practice good, compassionate, and scientific medicine in the community. Here in the academic towers there is some shelt

 

[astromeria]

"Lack of market forces" got 15% of the votes. How many of you would comparison shop for medical care (other than drugs)? Would you go to the low-bid surgeon? anesthesiologist? hospital? internist? pathologist? lab tech? obstetrician? Does anyone here do this already?

 

[Nords]

Would you go to the low-bid surgeon? anesthesiologist? hospital? internist? pathologist? lab tech? obstetrician? Does anyone here do this already?

No, I don't have to.

My TRICARE provider pre-screens the low-cost providers and chooses them for me. "Queens Hospital? I'd love to, they're the best! Tripler Army Medical Center? 2:40 AM next Tuesday? Oh, OK, thanks..."

 

[maddythebeagle]

oops, been gone a few days and didnt update the options fast enough..... I added your suggestions including "Fragmented delivery and payment systems"....but I intended that to be under "insurance paperwork"....that we hopefully wouldnt have as much of with a single payer system as the idea goes, I guess....

I also added lifestyle choices and others as I forgot several here do think it is a major issue.....

 

[perinova]

"Lack of market forces" got 15% of the votes. How many of you would comparison shop for medical care (other than drugs)? Would you go to the low-bid surgeon? anesthesiologist? hospital? internist? pathologist? lab tech? obstetrician? Does anyone here do this already?

I think lack of market forces is a major problem.
How do you find out which doctor is good?
How do you find the cost of services ahead of time (other than calling around)
Cost of a service that you can't do without in a time of urgent need is difficult.

I personally don't think that cost is up due to end of life issues, technology or what not. If that would be true why do I pay an arm and a leg for a quick office visit and lab work. No expensive technology there. No end of life issue.

I believe that high cost may be due to lots of equipment sitting idle, or hospital beds not used. This cost need to be absorbed.

Is there some splurging at some level (equipment manufacturer, drug companies, for-profit hospitals/doctors or insurance)? One would have to look at their financial statement to find out but profit doesn't show everything.

How to explain that in 2005 a cost of hospital bed was $4440/night in Kendall Park NJ and only $335 in Franklin TN? (US average $787).

 

[razztazz]

I think lack of market forces is a major problem

Yes but you see, the people who stand to make money don't like "market forces". There'll be no empowering the consumer with requisite product knowledge around here. If the customer had enough of the right knowledge it would be harder for the purveyors to shake them down. Why have a free market when you can keep your customer base in thw dark and on the hook? Economics 101

 

[Meadbh]

Health Care in Canada 2005 , published by the Canadian Institute of Health Information, shows that drug costs are rising faster than anything else. You can find it at....

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_376_E&cw_topic=376&cw_rel=AR_43_E

Of course, this poll is looking at underlying causes including population health. Many of these causes contribute to drug costs, including aging populations, more emphasis on ambulatory care, new and expensive drugs to try, and profit taking by Big Pharma.

And I agree completely with Rich about the Evidence Based Medicine. It can take 20 years for research findings to be integrated into clinical care, and we are very poor at implementation. Rich's comments on Canada in this respect are appreciated, but we also have a long way to go. For the past few years, Canadian research funding agencies have placed enormous emphasis on bringing evidence based medicine to patients. You simply cannot get a big clinical research grant now unless you can show that you are well set up to translate the findings into better care for patients. It's called Knowledge Translation and is one of my areas of interest (read passion).

 

[donheff]

I was looking for "uneccessary tests and procedures driven by fear of litigation."

 

[razztazz]

I was looking for "uneccessary tests and procedures driven by fear of litigation."

How about unnecessary tests, procedures, and drugs due to being able to shake down the insurance company? There's way more of that. To get off the hook for not doing a test you then get sued for all that is necessary is to get some other doctors to say they'd ahve done the same thing. Which they will because every group and pro9fession will always circle the wagons anyway. Poof! No malpractice. But the first instance, that practically defines the industry.

 

[perinova]

http://www.oxygenandgeneral.com/questions_answers.html

I was looking for somehting funny to put in here. I just found this. Read it a second time and realized it was not a joke.