1) Every few weeks or so, there is an “ED overcrowding story” detailing the crisis and its associated horrors.
My take: The story never seems to change, and always seems worse than the last one.
This is indeed a serious problem. Overcrowding leads to rushed treatment and missed diagnoses, not to mention that care in the emergency venue is often the most expensive.
The obvious solution would be to maximize access to outpatient and primary care. Retail and minute clinics are capitalizing on this demand and seemingly are thriving (until they get hit with the first big malpractice suit).
Physician access is key. Not only do we need more primary care doctors, the current ones need to find ways to maximize their access. Open-access scheduling and the ability to see walk-in patients are options to be considered.
2) A Washington Post piece suggests that preventive medicine doesn’t necessarily save money.
My take: Whether saving money should be the primary goal of a health system is for another debate.
What is problematic is that the costs of the Clinton and Obama plans are said to be partially defrayed by the emphasis on preventive care. That isn’t going to happen.
The progressives will have to convince the electorate that their primary goal of universal coverage is going to raise taxes cost more money. Period. Stop trying to hide costs by playing a shell game with preventive care and electronic records.
For the first time ever on this blog, I give John Edwards credit. At least he’s honest about the need to raise taxes if you want universal coverage.
Health is expensive. The public needs to understand that. Michael Moore does a tremendous disservice whenever he trumpets “free” European health care.
3) Digital mammograms are leading to increased recall rates for additional imaging.
My take: Another example of how the latest technology may increase cost and patient anxiety by necessitating further testing.
The latest diagnostic studies, like digital mammograms and breast MRIs, increase sensitivity at the cost of more “false positive” results. Since every finding needs to be followed up by increasingly invasive tests, like a biopsy, the probability of patient worry and test complications rise.
Related posts:
- How the government is banking on prevention to save money
- The cost of prevention: Bankruptcy
- Increasing caps = drop in physician access
- Reforming health care using the Massachusetts model won’t relieve ER overcrowding
- Pink eye in residency; Ban antibiotics; Infused coffee; How radiologists read mammograms; Pediatrics is dying
- Gawande on health reform: "It is not single-payer"
- My take: Heath Ledger, contracts, disease prevention
{ 5 comments }
Excellent Post Kevin.
I agree with you on all three points.
Increased access to outpatient primary care is indeed a needed part of addressing the overcrowded E.R. problem.
From personal experience, I can say that Open Access Scheduling can have a tremendous impact.
Also, getting away from 3rd party payers (including govt) and letting patients personally feel the financial effects of inappropriate ER visits (for minor problems) would likely help the problem I think.
Regarding the costs of preventative medicine, I agree that it is not necessarily a big money saver as far as what gets delivered on our end.
The reality however is that by far the most effective preventative medicine is free and doesn’t really need intervention from the medical profession. Not smoking is free. Not overeating is free. Turning off the television and going for a walk is free. Etc.
The studies show that it is expensive to provide patient education to tell people to not smoke, to eat right, to exercise, etc. and that the return on these expenses (in terms of lives saved/prolonged, decreased healt costs, etc) is a financial loser.
As a society, I think we need to be honest with ourselves however. Do we really need expensive programs to tell folks not to smoke, to eat right, to exercise, etc.?
Let’s get real here. Overwhelmingly, people already know this stuff. They simply choose to do the wrong stuff anyway. When they do, their health suffers and as a result their (our) finances suffer.
People don’t want to hear all this however. They just want a politician who will say “Let’s raise taxes and get you the free healthcare you deserve.”
If the voters really truly want to lower health care costs in this country, they should address their horribly unhealthy American lifestyles before they demand that our taxes be raised and that the medical profession be taken over by the government, or that corporations (who make huge political contributions) receive the gift of government mandated comprehensive health insurance for all.
Good points Kevin but regarding ER overcrowding. The research north of the border is that the overcrowding is mostly due to the elderly population lacking family doctors and chronic care beds. Every minor problem ends in the emerg. I don’t know if the same data holds true in the US but I wouldn’t be surprised. I understand a recent study confirmed that it was people with insurance that represent the biggest increase in users of ER services because of lack of access to the GP’s. I don’t agree with the open-access scheduling (same day appointments). There’s a fine line between block booking, priority booking and OAS but my understanding is that in OAS there can be 30-50% of time slots open at the beginning of the day. Nor is it a given that the no show rate drops. Here’s a link.
http://www.aafp.org/fpm/20060300/59impl.html
It’s a good academic look at OAS being used for 3 years. If Mass has a shortage of primary care even though OAS can only decrease wait times in conjunction with increased time slots to make up the backlog first than unused time slots second. I do agree that when used with block booking or on a homogenous patient pool that it’s a powerful tool.
http://www.waittimes.blogspot.com
Again, this goes to who is paying.
Preventive health care might cost more to the health care system but be cheaper for all social services and result in increased tax revenues.
Kevin, I normally agree with you on nearly every topic. However, your take on digital mammograms increasing call-back rates is inaccurate. I can’t decide if this due to only a cursory reading of the article, which very clearly and fairly explains the issues with digital mammograms, or from the fact that you have never experienced the pleasure of sitting down in front of a completely full screening board. I imagine it’s a little of both. The article plainly states that the increase in recall rates is due to the TRANSITION between digital and analog mammograms, not the digital mammograms themselves. The striking difference between the two techniques complicates the biggest tool a mammographer has in his arsenal – stability. A digital mammogram looks completely changed relative to it’s analog counterparts of prior years, thus increasing call backs for “developing densities. My guess is that the call-back rate will come back down to normal once digital-to-digital comparisons are the norm. Unlike MRI, this is not an example where the sensitivity of the technology itself is responsible for increasing costs.
drsam – can we nominate you for surgeon general? I think those are very true words.
The best things in life are free, but you have to want them.
We’re a sorry nation that someone has to be paid to tell us to take care of ourselves!
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