I reported last week on the Trump Administration’s CMS rollback of Medicare cost-saving bundled payment programs. Two Obama-era health policy advisors penned a Wall Street Journal op-ed to further describe why these changes are a bad move.
“This fee-for-service model, which has dominated American health care for decades, is hardly efficient. Paying for inputs—tests, procedures, hospital stays and the like—creates incentives for overtreatment, with little regard for coordinating care or improving patient outcomes…Now the Trump administration is re-embracing the old fee-for-service model. In six months, the Department of Health and Human Services has gone from driving innovation to dragging health care backward.”
What would it take to make the US health care system the best in the world? We already spend more money (by far) on health care than any other country, but our results are middling (see the figure below). Recent thoughts on what the US might do in order to translate our huge financial investment in health into better results, in the NEJM.
“The first challenge the U.S. health care system must confront is lack of access to health care…Affordable and comprehensive insurance coverage is fundamental. If people are uninsured, some delay seeking care, some of those end up with serious health problems, and some of them die.
The second challenge is the relative underinvestment in primary care in the United States as compared with other countries…In contrast to the United States, a higher percentage of these countries’ professional workforce is dedicated to primary care than to specialty care, and they enable delivery of a wider range of services at first contact…” Continue reading Health Policy Updates: August 19 2017→
The Kaiser Family Foundation recently released a series of charts explaining various aspects of drug costs – the impact of the new hepatitis C drugs, the “doughnut hole” closure, etc. My personal favorite was this one, showing the high amounts that Medicare beneficiaries have to pay out-of-pocket for some drugs, despite having Part D coverage.
After this study made the news several years ago, it became common knowledge that “doctors die differently” from the rest of us. Having been behind the scenes in providing care to dying patients, the story went, doctors know how ineffective and truly painful such care can be. As a result, they are more interested in Hospice care, and they forgo such interventions such a CPR when they finally reach the end. If only everyone knew what doctors know, then they could be spared the agony and indignity of dying in a hospital!
In contrast, a more recent study finds that doctors really don’t differ from everyone else. It seems like they spend just as much time in the hospital, and in the ICU. I was surprised by this finding; if true, it makes me more pessimistic about the ability of more information or education to help people to avoid painful, costly, low-value care at the end of life.
“They found that the majority of physicians and non-physicians were hospitalized in the last six months of life and that the small difference between the two groups was not statistically significant after adjusting for other variables. The groups also had the same likelihood of having at least one stay in the ICU during that period” Continue reading Health Policy Updates: June 11 2016→