Figuring out how to fully contain healthcare costs is one difficult task. It reminds me of the age-old impossibility of trying to close your hand completely around a balloon that, while partially deflated, still has a little bit of air in it.
No sooner do you get your hand tightly closed, and think that you’ve done it, than the little bit of air in the balloon pops out somewhere. Readjust your hand, and that little bit of air just pops out somewhere else.
There’s something about cost containment that seems simple on its face but, because of the complexity of the underlying economic forces, just doesn’t work in the real world.
As a result, we’re left to deal with things that just don’t work as intended, with systems that fail or work in inverse ways, or the unmet needs of a constituency within the system.
It’s no wonder, then, that as long as the industry and those trying to “help” it pursue piecemeal solutions, we’ll have to deal with incongruities and shortcomings that no one expected or seem vexing to solve.
A number of these struck me as I was doing the research and reading that I typically do each month. There’s no particular string that ties them together, other than the thread that we all need to do some deep thinking and research on cause and effect to make healthcare more cost-effective.
For example, writing in anticipation of healthcare spending cuts by the state of California as it deals with a massive budget deficit, Anthony Wright, executive director of Health Access California, points out one of those “balloon squeezing” moments:
“Here’s the problem in healthcare and other social services,” Wright wrote recently. “It is exactly during bad economic times, when policymakers are seeking to cut the state budget, that healthcare services are needed the most. It’s countercyclical; when economic times are good, people are more likely to be able to get and afford private coverage. The need for public health programs grows at exactly the time that state revenues start to dry up and this, in fact, exacerbates the budget crisis.”
Wright suggests raising revenues in the state through a ballot initiative for healthcare reform would help meet healthcare needs and reduce the pressure on the state’s general fund.
Sometimes, these counterintuitive results just show that the industry lags behind what a constituency group wants. For example, results of a study by Regence, a Portland, Ore.-based Blues insurer, found that consumers are ready and willing to do comparison shopping for healthcare services.
In fact, data from the Regence study indicates that seven out of 10 consumers would seek out information such as price and quality for medical services.
Of course, the problem here is that the presentation of such information is piecemeal at best, providers are not always willing to share it, and it’s difficult to decipher and present the nuances that influence costs of care and patient outcomes. So, the industry has a long way to go before it can adequately meet the needs of consumers, who are willing to try to intelligently shop for healthcare.
The next disconnect that struck me was a recent press release from RxHub, which announced last month that its National Patient Health Information Network can provide clinicians with real-time secured access for decision-support information for more than 200 million patient records at the point of care.
That’s impressive, exhibiting a capacity to get information to the point of care, and one that has been a dream of many in the healthcare IT industry for years. But wait a minute, only a small percentage of the nation’s physicians are using electronic prescribing – that might be under 10 percent, according to data presented at the November meeting of the American Health Information Community.
The industry needs to find ways to nudge physicians toward electronic prescribing, so that this decision support information can find its way to the support of care when it’s being delivered.
The last disconnect I’ll mention is a big one –the studies that consistently rank the U.S. as providing less than optimal care for the cost. Most recently, research sponsored by the Commonwealth Fund found that Americans get the worst deal in terms of preventable deaths. The authors found that while other countries dramatically reduced preventable deaths by the use of preventable healthcare, the U.S. did so only slightly.
This data comes only a couple weeks after government data reported U.S. healthcare expenses totaled $2.1 trillion for 2006, or more than $7,000 for each person in the country.
The sooner we make progress on some of these anomalies, the better for everyone.