Reducing the cost of health care

Reducing the cost of health care

Summary: At the May meeting of the National Association of State CIOs, HHS Secretary Mike Leavitt had some bad news about Medicaid:"Medicaid expenditures will exceed public education expenditures for the first time this year. If health care begins to push out all other priorities, it throws off the economic equation.

TOPICS: Health

At the May meeting of the National Association of State CIOs, HHS Secretary Mike Leavitt had some bad news about Medicaid:

"Medicaid expenditures will exceed public education expenditures for the first time this year. If health care begins to push out all other priorities, it throws off the economic equation."

For most states, public education is the lion's share of the budget and is viewed as an investment in the future.  Seeing that crowded out by something else, even something with as noble a purpose as health care is troubling. 

Leavitt, true to form, challenged the State CIOs to use technology to help solve the problem and lower health care costs.  You may wonder what  your state government can do to lower health care costs.  I believe they can do a lot.

A few states, like Utah and Massachusetts have state-wide "networks" for interchanging health care information.  Utah's network, UHIN,  has been providing doctors and insurers a standardized way to exchange payment information for years.  Now, UHIN is part of an HHS pilot project to use that same network to exchange clinical information as well. 

If you're familiar with exchange points on the Internet, you can think of these health information networks in much the same way.  Someone has to connect the various payers and payees together, but it's difficult to imagine who's job it is, who sets the standards, and so on.  State's can play a significant role in bringing the various parties together and serving as an honest broker.

The technology to make this happen isn't difficult.  The real problems are political and economic.  State CIOs can use their "convening authority" to help break down those political and economic barriers and, with some luck, remove some of the overhead from the health care system.   

Topic: Health

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  • Great... More personal information for someone to steal...

  • There's only one way to fix Health Care...

    And that's to fix the out-of-control pharmacutical companies.

    The first thing that needs to happen is to outright BAN advertising by the pharmacutical companies. We, the patients, are paying for all this high-cost TV advertising.

    And it's useless advertising. The patient isn't the one that should be deciding on what drugs to take. That's the Doctors job. HE should get the info from the trade journals, AMA information, etc... and present the choices to the patient.

    Having the patient walk in and say "I need Viagra" or whatever is the dumbest thing that has ever hit the medical scene.

    There is a reason Lawyers were not allowed to advertise on TV for so many years. It's pretty clear why that should have never changed.
  • Understanding health economics

    Everyone would like to believe that there is a quick fix to the nations health care woes. Unfortunately, that seems to be the American way. If everyone understood health economics they would realize that we are in a downward spiral.

    There are several reasons for the continuing push upward in the costs of health care. One is clearly the cost of drugs and yes, it would help if the costs were not further inflated by the mass advertising done directly to the public. It would also help if the manufacturers were required to adopt pricing strategies that were not tied to each countries health care economic model.

    However, the underlying causes for increased costs have to do with the American culture. The American health care consumer wants the latest technology and the latest medicines and immediate service, regardless of whether they need it or not. We do not tend to deal well with being told that we have to wait for something or don't need the latest technology. Why get a simple xray when a MRI is available? Why take Penicillin when the latest antibiotic kills everything? Never mind the cost, isn't that what my insurance is for anyway?

    Ultimately the shift of health care costs to the consumer will lead to changes in the ways in which we obtain health care because we will have to pay for it out of our own pockets. It is amazing how frugal we can be when someone else is not taking care of things for us. The concept is called accountability and we need to take some to be better health care consumers.

    One key component missing in the discussion is quality of life. We are fooling ourselves if we believe that we can ever get costs under control if we also believe that life, in any form or at any level, is worth maintaining. As our population ages the costs will mushroom even further.

    The other issue is accountability for maintaining your health. Most Americans engage in at least one, many multiple, forms of abuse of our bodies whether it be alcohol, smoking, eating, etc. Yet, there is no penalty for those who abuse their bodies when it comes to purchasing health care. There is a penalty when it comes to purchasing life insurance. If we are to see changes in the way people treat their own bodies there has to be a risk-reward approach. Lower the cost of health care for those who use it less or increase the cost for those who use it more or both.

    Most of the tough decisions that need to be made are less economic than moral and ethical in nature. For instance, there is a new chemotherapy regimen available for patients with colorectal cancer. The treatment only extends the life of the patient. It is for those in end stage cancer. A patient on average will live an additional two months. The cost of the treatment is $60,000.

    There are no easy answers. Much of the research necessary has not been done and there is little incentive in the existing medical establishment to perform studies showing that their services could be used less or should cost less.

    In the meantime be prepared for ever increasing costs in every aspect of healthcare from higher co-pays, co-insurance, deductibles, premiums, and care to more advanced technology which extends the life of patients, regardless of quality, and therefore increases the lifetime costs of care.

    Start saving now.
  • Info Security & Usefulness

    For openers, if you're on Medicaid, or Medicaid & SSI, a common combination, they have already accessed and collected the details of your life, as well as payment data, so what else that might save them money would be new?

    HIPPAA was intended to protect individuals' medical privacy. The only people better off as a result of all of its sometimes expensive and burdensome requirements seem to be stockholders in paper companies.

    Since on-line medical records do have some possible benefits for patients as well as for insurance companies, Medicare, Medicaid, and other government agencies, and much of the data is already computerized one way or another, I have decided we should not fight the inevitable universal system but that its security is vitally important to the repeservtion of a free society.

    Of course this data, or such of it as anyone wants that has not already been stolen by data miners and aggregators for commercial sale, will be stolen. Do you really believe that there are not copies of all the individuals' data the Social Security Administration put on line birefly years ago, supposing it would be available only to those respective individuals and their health ae providers, in the hands of the big credit and data brokers, who Business Week reports also collect prescription data etc., already? I read one page on Microsoft's small business site some time ago that urged businesses, and offered advice how, to invade the medical privacy of current and prospective employees, and plenty of sites offer this kind of sensitive personal data. One ZDNet site included experts raising really serious issues whether the private data collection companies responsible for setting up and running on-line medical records systems are even covered by HIPPAA as now drafted, and, given the money spent to gut it and the time and effort to get anything passed the last time, although most voters, regardless of party, wanted strong privacy protection, but didn't really get all they should have, what will it take to get more now? The people with the money to spend on this issue want their hands in our records and pockets.

    An honest audit of where the Medicaid money is really going, for what, and in whose pockets it is ultimately ending up, maybe by the nonpartisan Congressional Burget Office, might provide a good start on how to hold down costs without simply deciding to deny care or maybe just to kill off anyone with an expensive medical condition.

    I personally know of a not-uncommon situation where Medicaid ended up paying for expensive work including a CAT scan necessitated because, and only because, Medicaid would not pay for the urgent dental care that would have headed off the need for the medical treatment until it led to abcesses and the patient's face swelling badly, so hte patient, unable to afford dental are, had to go to his primary cre physician for treatment of that.

    I also know of a medical device, which could proably be custom built for a tenth of the price of the mass-produced version, for which Medicaid pays about twice the retail price on the iten in a small-town medical supply store.

    How much expensive medical advertising to the public is really paid for by Medicaid and Medicare which pay for a large percentage of all prescriptions?

    I recently saw data, on a reputable news site, that more people are getting shot, stabbed, etc., and the real reason the murder rate is down is that better emergency care is saving lives that used to be lost. If that's true there, consider the rest of the medical system.

    Have you ever weighed the paper poor Medicaid patients get in a year? Why in the name of common sense do they send English speakers 50 pages of Spanish and Spanish speakers 50 pages of English, when they have, or courld easily get, this data, for example? You could save a lot of trees if they just quit giving stupid and offensively intrusive advice that everybody already knows.