Motivation
In A Pound of Cure, published in the July/August MIT Technology Review, Andy Kessler challenges the possibility of addressing the cost of health care without addressing the motivations of the health-care industry. He references the recent Dartmouth College study that suggests, based on analysis of 4,000 hospitals, that eliminating 30% of the resources committed to Medicare patients contributed nothing at all to the outcomes of the patients. He doubts that the $19 billion for health-care IT projects included in the $787 billion Obama stimulus package can accomplish anything.
Elsewhere I have stated my opinion that fully 50% of all health care spending could be eliminated with a combination of electronic records and diagnostic software. Electronic records would make it easy to use data-mining software to evaluate the success of different treatment regimes for various ailments. (If a patient knew there was an 80% probability of success with a $1,000 treatment and an 80% probability of success with a $1,000,000 treatment, which one would they choose?) Diagnostic software would help focus diagnosis, eliminating billions in wasted tests.
But as Kessler points out, the health-care industry makes more money when it consumes more resources. The bias of practitioners with an economic stake will always be to spend more. There are few, if any, practitioners with no economic stake.
This is, and will remain, a stubborn problem. If I Were King it would be no different. Better health insurance will not help, that just means that each patient has more resources available. The only thing that has a chance is a combination of patient understanding of the costs and benefits of different options, and an economic stake in choosing among them.
Should we spend a million bucks to keep Mom on life support for another six months? What if that means that nobody in the family will see a dentist for the next ten years? Clearly there are times when heroic (read: expensive) efforts are worthwhile, and times when they provide no more benefit than burning the same amount of currency.
We need better understanding of the costs and benefits, which open electronic records will enable, and then we need to empower patients and families, consulting with health-care professionals, to make judgments about the resources to be used. The industry’s motivation will always be towards growth in spending, I see no reason why we can’t cut that spending in half in the next ten years.