Universal health care - best I've seen

[Rich_by_the_Bay]

The recent American College of Physician position paper on health care reform is heavy reading, but if you are looking for a sound, reasoned, nonpolitcal fact-based document, this is the best I have seen recently.

It discusses cost, quality, work force issues, other countries' systems and backs it up with data. Not light bedtime reading, but .. wow.

If ever an issue affected a group directly, this one should wake up us Boomers and those who'll follow.

 

[tomz]

Thanks for posting this. It is a comprehensive document that nicely summarizes the current state of affairs and it uses real data rather than anecdotes.

 

[REWahoo]

If ever an issue affected a group directly, this one should wake up us Boomers and those who'll follow.

Too bad it isn't waking up our wandering herd of presidential hopefuls...

Politics, business as usual in health proposals?

"Candidates' plans to bring little reform, don't address costs, analysts say"

"Those who hope the 2008 presidential election will finally bring about drastic health-care reform may well end up finding it's a case of politics and business as usual, experts say."

"It's still early in the race to the White House, but right now there doesn't appear to be much in the way of strong shifts on the horizon for what many consider the nation's highest domestic priority if current proposals from the handful of presidential hopefuls are not altered."

"The one idea that could cause the most upheaval -- mandatory coverage for all -- is meeting with tremendous skepticism and is given little chance of passage, at least on the national stage. Other proposals circulating now are short on pragmatic solutions, experts agree, and don't really get at the heart of the matter -- an out-of-control cost structure."

 

[tightasadrum]

Not exactly a ringing endorsement of the US vaulted healthcare system is it. Just like everything else, I don't expect much to change until the system has foundered on the rocks. Politicians are too concerned about real earthshaking issues like gay marriage and raising money to get re-elected. I've said it before, until the lawmakers are forced to swim in the same pool of financial issues we do, I don't see much chance for positive change.

 

[donheff]

That is a good paper to cite when the inevitable health care policy wars break out on various threads. Thanks Rich.

 

[Martha]

It is also a good paper to send to your senators and representatives. Though I question their desire to be educated.

 

[haha]

The recent American College of Physician position paper on health care reform is heavy reading, but if you are looking for a sound, reasoned, nonpolitcal fact-based document, this is the best I have seen recently.

Hard to think of a better credentialed group. Over time, this should carry political weight.

Ha

 

[Nords]

It is also a good paper to send to your senators and representatives. Though I question their desire to be educated.

I'm sending mine a copy printed on $100 bills. I'm sure it'll get the attention of the right people...

 

[imnxpat]

The recent American College of Physician position paper on health care reform is heavy reading, but if you are looking for a sound, reasoned, nonpolitcal fact-based document, this is the best I have seen recently.

It discusses cost, quality, work force issues, other countries' systems and backs it up with data. Not light bedtime reading, but .. wow.

If ever an issue affected a group directly, this one should wake up us Boomers and those who'll follow.

That is a great article, Rich. But I fear that the portion of the title "What the United States Can Learn from Other Countries" will turn off a lot readers because Americans tend to think that they know it all and are unwilling to heed international advice.

 

[RetireeRobert]

Very good paper. It seems to be an attempt at ferreting out "best practices" for health care systems. Glad to see such attempts being made and discussed by an authoritative body such as the Amercian College of Physicians.

For an interesting comparison, look at the ranking of countries on page 3 figure 3 in this report which shows percentage of expenses paid out-of-pocket by patients in each country.

Then look at the ranking of the same countries' health care systems in the WHO ranking (see my recent post for link). France is number one on both lists, but otherwise the countries vary all over the place as to rank from one list to the other.

So, while WHO tried to rank countries healthcare systems by some measure of "best" (meaning access, outcomes, expense, etc all rolled into one measure), the figure 3 ranking in this American College paper looks only at patient out-of-pocket cost by country. Would have been interesting if there was more congrousness in the two rankings!

 

[lets-retire]

I'll admit I didn't read the article, but I did look at the pictures. The thing I find surprising was the chart showing how the health care dollar is spent. It seems to me we could save a lot of money by lowering costs that could be easily lowered. The way I read the chart the easiest costs to lower would be salaries. Research and structures are included in the "Other Spending" category and the Admin category, I would presume includes all of the time it takes to fill out charts and file insurance. These together (I'm being generous) total less than 32% of the spending. While money spent for actual treatment and medicine totals over 68%. We all know labor is the expensive part of any business so lower the doctors' pay and we will all be able to afford reasonable health care. Until there are not enough doctors to go around or have we already hit that mark and that's why doctors' pay is so high.

 

[Freein05]

I was at my doctors today. He order some lab work, and an X-ray. The lab work and X-ray are done at different firms. It hit me while I was waiting for the X-ray in mega X-ray corporation's lobby. That there were three profit centers making money off of me. Actually fsix. The doctor order some medication so the pharmacy and drug company also made money. I have included my insurance company as the 6th. They did not make money today but they make money every year off on my $13,000 a year premium.

If I would have had to had surgery you would add at least two more profit centers. The surgeon and the hospital. With so many profit centers in our current health care system I can not see any other fix for it other than Universal Health Care.

 

[Gotadimple]

I'm Confused?

I was at my doctors today. He order some lab work, and an X-ray. The lab work and X-ray are done at different firms. It hit me while I was waiting for the X-ray in mega X-ray corporation's lobby. That there were three profit centers making money off of me. Actually fsix. The doctor order some medication so the pharmacy and drug company also made money. I have included my insurance company as the 6th. They did not make money today but they make money every year off on my $13,000 a year premium.

If I would have had to had surgery you would add at least two more profit centers. The surgeon and the hospital. With so many profit centers in our current health care system I can not see any other fix for it other than Universal Health Care.

How does universal health care eliminate profit centers?

 

[Freein05]

You are correct Universal Health Care would not eliminate profit centers. I was wrong. The point I was trying to make is that there are too many profit centers in our current health care system.

The only way to cut the cost of health care is to eliminate so many profit centers. This is the big stumbling block to fixing and controlling health care costs. There is just too much money in it for a lot of people. Those countries that have been able to control costs also set the price for services which may or may not provide room (profit)for services to be provided by private companies. Most of these countries set the fees for medical services and the medical providers basically work for the government. I do not see this happening in the US. Our system may be beyond fixing.

 

[kcowan]

You are correct Universal Health Care would not eliminate profit centers. I was wrong. The point I was trying to make is that there are too many profit centers in our current health care system. ... Our system may be beyond fixing.

The Xray is earning a set fee and so the center has to become efficient enough to survive on those prescribed fees.
The lab specializes so that they can do the tests better (cheaper0 than other alternatives.
Walk-in clinics flourish because they can treat you faster and cheaper than either a trip to your doctor or to emergency.
Hospitals do private fund raising and get capital for building and equipment that does not need to produce an ROI.

The fundamental problem is rewarding the system for higher activity levels rather than improved health outcomes.

 

[Rich_by_the_Bay]

The American College of Physicians, along with other organizations, is supporting a care delivery model known as the "Advanced Medical Home." It includes reasonable payment to well-trained primary care physicians for the purpose of coordination of care, first-stop assessment for virtually all ailments, and a number of other important behaviors which are currently either inadequately reimbursed or billable (e.g. authorizing referrals for HMOs, refills, family conferences, phone calls, after-hours availability).

It would reduce repetitive profit-driven care practices. Together with universal coverage, it seems like a good start to me. Though I did it for over 10 years early in my career, I would not consider entering private practice in primary care today. It is economically and life-balance-wise not a sustainable career. If an initiative like this ever took hold, I might change my advice to young physicians.

 

[USK Coastie]

Hospitals do private fund raising and get capital for building and equipment that does not need to produce an ROI.
Kcowan Having spent several years in Health care Facilities management I can say that your premise that health care facilities do not need an ROI is incorrect. In the US a health care facility is considered to be doing "ok" if it makes 4 - 5 % on the gross income. This amount will pay for technology changes and upgrades to systems and facilities which need to be replaced completely every 25 - 30 years. Most non profit Health care runs at or below this number. In our area the third largest Hospital in the state did not meet this margin of 4% more than 5 of the last 10 years. In addition they gave away/wrote off 30 -40 million each year in bad debt/charity care or about 10% of their annual gross.

 

[cute fuzzy bunny]

I'm presuming that most nationalized/universal health care plans would eliminate private insurance companies and their profit, negotiate reasonable prescription rates (a la medicare), and eliminate the stupid overcharging for the uninsured, along with most of the BS, bureaucracy and paperwork. Thats allegedly how the current state systems are configured, paying part of the cost through elimination of extra profit layers and overhead.

Whether it would actually work that way is another story.

Interesting watching the national news last night. Two back to back stories near the end.

First one was on medicare fraud. Their big point was that medicare does all their payments via automated computers "which is inferior to private insurance companies who have a lot more oversight and who would catch most of this fraud". Next story was on a new program in Boston that has people stay at home and pay for an in-home care program. Much cheaper than a nursing home and you get to stay in your own house!

Anyone else get the same two takeaways I did from that?

 

[Gotadimple]

The American College of Physicians, along with other organizations, is supporting a care delivery model known as the "Advanced Medical Home." It includes reasonable payment to well-trained primary care physicians for the purpose of coordination of care, first-stop assessment for virtually all ailments, and a number of other important behaviors which are currently either inadequately reimbursed or billable (e.g. authorizing referrals for HMOs, refills, family conferences, phone calls, after-hours availability).

It would reduce repetitive profit-driven care practices. Together with universal coverage, it seems like a good start to me. Though I did it for over 10 years early in my career, I would not consider entering private practice in primary care today. It is economically and life-balance-wise not a sustainable career. If an initiative like this ever took hold, I might change my advice to young physicians.

Rich, so how does this differ from capitation which most HMO's paid to primary care givers? Is it that the range of services expected is broader and the capitation payment is greater per patient?

 

[Rich_by_the_Bay]

Rich, so how does this differ from capitation which most HMO's paid to primary care givers? Is it that the range of services expected is broader and the capitation payment is greater per patient?

Good question. Capitation refers (generally) to a fixed amount paid for all necessary services. It is used mostly in hospital coverage contracts and some HMO contracts. Advantages: it coerces low, predictable expenses. Disadvantages: it sometimes crushes the providers who enounter even a small number of unforeseen catastrophic cases; it generates onerous situations. Just last week I had a patient in need of a high cost PET scan. The plan would only cover this as outpatient care (not part of captiated inpatient care). The patient had to drive back 4 hours each way plus a hotel bill just to get her PET scan, which could easily have been done on the day she was discharged.

As far as the medical home consult. the coordinating services would be reimbursed at a negotiated rate, but all disease specific care would be excluded. It's more like a retainer than capitation. Hope that helps.

 

[Moemg]

Rich,
Excellent article .I worked for a group of orthopedic and pain doctors in a large building .The amount of staff involved in direct patient care was dwarfed by the amount of staff handling billing and paper work .

 

[kcowan]

Hospitals do private fund raising and get capital for building and equipment that does not need to produce an ROI.

Kcowan Having spent several years in Health care Facilities management I can say that your premise that health care facilities do not need an ROI is incorrect. In the US a health care facility is considered to be doing "ok" if it makes 4 - 5 % on the gross income.

The ROI I was referring to is from the invested capital that is raised from benefactors. You are talking about them making a small operating profit. No argument with that.