The realization that the American health care system must simultaneously decrease per-capita cost and increase quality has created the opportunity for the United States to learn from low and middle-income countries. "Reverse innovation" describes the process whereby an inexpensive innovation is used first in countries with limited infrastructure and resources and then spreads to industrialized nations like the United States.The traditional model of innovation has involved the creation of ...

A guest column by the American Medical Association, exclusive to KevinMD.com.Every year since 2001 the threat of severe physician payment cuts, imposed by Medicare’s failed sustainable growth rate formula (SGR), have jeopardized the stability of the Medicare system and compromised access to care for patients. And every year – sometimes several times a year – Congress has put in place short-term ...

The current reorganization of health care could make it better and cheaper for everyone, harnessing real creative and competitive energies to build the "next health care" —or it could lead to local monopolies, higher prices and less real competition where it matters. The many and various moves toward accountability, competition and transparency could defeat themselves.The theme of the reorganization is clear: new types of cooperation between physicians, hospitals and other ...

In the September 2011 issue of Harvard Business Review, Harvard Business School professors Robert Kaplan and Michael Porter argue that a better understanding of the actual cost of care patient-by-patient can have a dramatic impact in the effort to control health care costs. They maintain that actual costs are poorly understood, that there is a mistaken belief that many costs are too complex to allocate accurately, and that ...

Robert Brook, MD, health services researcher extraordinaire, wrote a provocative commentary in JAMA – as he is accustomed to doing – entitled “What If Physicians Actually Had to Control Medical Costs?” In his piece, Brook challenged physicians to take a lead role in addressing the cost dilemma and called on physicians to find alternative strategies to rationing.No matter how spot on Brook was in his call to physicians to ...

Here are my next two principles of affordable healthcare reform.First, medicine must be practiced in a manner and in a place that is consistent with economic efficiencies, evidence based outcomes and the needs of the specific community that it serves.In healthcare delivery, quantitative must be balanced by qualitative. Specific community needs and the culture of that particular community must have equal and in certain cases, greater value than the ...

I’ve written before about how children from poor families have a higher chance of needing PICU care than do children from more affluent families. Eligibility for Medicaid is a good marker for this; nearly half the population of most urban PICUs is made up of children on Medicaid, even though the national average (it varies a little from state to state) for children on Medicaid is about 25%. So poor kids are ...

In this enlightened era of evidence-based medicine, you'd think that the progressive academics, viziers, and mandarins who are cluttering the policy making commentariat would pay more attention to what was tried before. That should be doubly true if those lessons come from that health care nirvana called Europe, where enlightened central bureaucracies wisely allocate health care for its caffè sipping, plaza strolling and beret adorned citizenry.Case in point is ...

To paraphrase Clayton Christensen, author of The Innovator's Dilemma, when discussing healthcare, disruptive forces set the stage for meaningful innovation and consumer cost reductions.This is where we now find ourselves. What percentage of our nation's GDP is reasonable to spend on healthcare - 15%, 20%, 25%? What adaptations are necessary to maintain high quality for those who now receive it and simultaneously provide access to primary care and preventive ...

While liability reforms have been good for the health of Texans, many laws favored by Governor Perry have damaged health.  As a physician on the Committee on Public Health of Bexar County Medical Society, I have been trying for many years to help not only my patients, but also Texans in general.  San Antonio, my home for the last 30 years, is reported to have a population mix very similar ...

Yesterday was no different than many other days in my life as a consultant.  Two clients, three cities, and finally arriving late evening at the hotel. It had been a long day of travel and I was looking forward to getting into my room and off of my feet. As I got onto the elevator, for some reason, the inspection certificate caught my eye and I felt compelled to read ...

I have come up with the idea of the century.  My idea will make your company the richest in the world while attracting millions of new patrons to your credit and debit card services.  I don’t know why no one has done it in the past.  It has made the insurers of America countless billions of dollars and now you can profit as well.  My only request is that you ...

"Do you know how many people died in car crashes in the United States in 2010? 32,000. That’s the lowest number since 1949. That’s impressive, but wait: It’s far more impressive than it sounds at first, because people in the United States drove about 10 times as many vehicle miles in 2010 as they did in 1949. In other words, if you drove a car or truck in 2010, you ...

It's really quite an ancient debate: 400 to 500 years before the birth of Christ, on the island of Kos (home of Hippocrates) originates the myth of Aesculapius, god of healing, son of Apollo and the nymph Coronis.As is not unusual in Greek mythology, Coronis meets a violent death, but the infant Aesculapius is saved. He is raised by a wise centaur, becomes skilled in healing arts, and succeeds in ...