McKinsey blames technology for our health care woes
Summary: Add these expenses to our prescription drug epidemic and you see American health consumers subsidizing American dominance of the healthcare technology industries.
Imaging technology represents much of the "waste" identified by McKinsey Global Institute economists in a new breakdown of the U.S. health care problem.
Outpatient care accounts for 41% of total care and 67% of total "waste," and its growth is out-of-control, according to the report.
CT scans, knee replacements, and other expensive treatments are routinely approved without effective controls. Robert Samuelsen of Newsweek calls this a political problem.
But there is another way of looking at it. Add these expenses to our prescription drug epidemic and you see American health consumers subsidizing American dominance of the healthcare technology industries.
That is the flip side of this problem. American companies still dominate the market in medical imaging, in pharmaceuticals, and in operating room technology because their home market consumes, almost without question, every advance they make.
To make money in Europe or Asia their competitors are limited to serving high-income patients.
Access to the mass market requires jumping through government approvals where there are immense political pressures to just say no, and hard bargaining if approval is granted.
I have participated in this just like everyone else. For my knee pain I got an x-ray, without wait or question. For my back pain I got a CT scan, ordered by a chiropractor. And the insurance company paid.
It's very likely I would have had a long wait for these procedures in Europe, and very possible they would have been denied. In both cases I recovered on my own. Rest cured the knee. Weights cured the back.
The promise of HMOs was that such expenses could be reduced, that having a gatekeeper stall or deny high-tech care could save money. It did, for a time. Then HMO care became subject to the same inflationary pressures as every other form of care.
These are the kinds of answers the push toward an integrated system of EHRs is designed to find. But, as with decision support on medical decision making, it may turn out the data was there all along.
The problem is, as Samuelson notes, "What others call 'health costs' are their incomes -- wages, salaries, profits." Saving Peter means ending subsidies to Paul.
Samuelson's own proposals for ending the subsidies -- taxing benefits, charging more for Medicare, imposing a tax to cover government health costs -- are only half the answer.
The other half is having someone just say no to unnecessary high-tech care.
Kick off your day with ZDNet's daily email newsletter. It's the freshest tech news and opinion, served hot. Get it.
Talkback
Give us old folks the little blue pill
Samuelson is obviously one of the more
affluent of us as we move toward old age.
Quite happy to increase costs of medical
care and reduce expensive services for
those on Medicare.
Might as well just give us the "little blue
pill" (as my late mother-in-law would say)
and be done with us.
While I'm not firm believer in spending a
fortune to keep some one alive an extra
day or two I do believe in moving
medicine forward, not backward.
That means continual investments in
things like organ and bone marrow
transplants, actually using imaging
technology that;s currently available and
caring for patients as if they were a
member of your family.
As far as us old folks go - hey, we've paid
our dues. Paid gas taxes since we were
16 and you have a lot of roads to drive on
because of that. Same with schools and
other bits of infrastructure younger folks
take for granted.
Sometimes it appears to a layman that a
test isn't really needed. Like a CT scan for
a sore back. Looks like a waste of time,
unless you're one of those patients that
suddenly have a Dx of bone cancer, or a
tumor that has spread from prostate
cancer.
The more medicine advances the more
people of all ages can benefit. There is a
huge social benefit in ensuring that
everyone has access to basic medicine -
even when the definition of "basic
medicine" continues to expand. We've
been that way for a long time, which is
why we don't need rows an rows of iron
lungs in the hospital basement like we
used to have.
Cost controls on technology
suffer in terms of outcomes, yet pay one-third less
and more.
No one in America is suggesting doing away with the
private system, or allowing those who are dissatisfied
to buy care on their own dime.
But either through the insurance system or a
government system costs must be controlled. We're
being broken, all of us, because they are not
controlled.
Focus on surcharges to control costs
coverage for my wife and myself. That, to be
blunt, is far too expensive for too many people.
So they drop out. No surprise there.
Providers, like hospitals, understand this situation
and increase individual charges to cover these
costs. It's called a surcharge.
Until we have a situation where providers are fairly
paid for each treatment or procedure we will
continue to be charged this surplus. No surprise
there either.
Universal care does address this issue and, if fairly
managed, can reduce individual charges. That
allows for overall cost reductions without denying
individual treatments.
Once a hospital or clinic installs a piece of imaging
equipment the fixed costs mean that the
maximum use of the device will result in the lower
per unit charge. The key issue, however, still gets
back to the surcharge concept.
...and waste adds surcharge!!!
but by over-using it, they're passing the cost of having gotten a machine to everyone... and they're making everyone EXPECT the over-treatment...
if you have a back-ache, 99.9% of the time, it's just minor mis-alignment and/or muscle pain. A professional who is properly trained shouldn't need a CT scan to tell them that!
OVER investing leads to over using, leads to lazy diagnosis and overcharging, the latter leads to wasteful costs! If the CT scan does nothing for your case, but takes time and energy out of your life... why should you suffer the medical insurance cost for it? (as the insurance company would note it, and your rates are affected accordingly...)
*THERE* is the problem. the lack of controls on investment, the lack of controls on spending... the lack of the test of "reasonable"... Should anyone have $1200 spent, when a chiropractor should be able to check with their hands for <$200, in under 15 minutes? (oh, and if it's a spine problem, the chiropractor should have it fixed within 15 minutes beyond!)
Chiropractor, Ha! (nt)
A "Gatekeeper" is coming.
Dana's right about that and if that is what he wants he will soon get it, not long after January 20th! ;-)
American healthcare will certainly become more like Europe's under President Obama and the Democrats. Let's hope that's a good thing.
Of course the flip side of controlling costs is denying medical care. I wonder if that is what people envision when they speak of "free" government provided healthcare?