Medicare for All faces big data, privacy, technology hurdles, says CBO

The Congressional Budget Office highlighted the IT challenges with a single payer healthcare model, but also noted that Taiwan may have a design that would keep costs down.

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Medicare for Al or a single payer health system -- a proposal being floated by presidential candidates -- would face numerous challenges to implement and information technology would be a big one, according to a Congressional Budget Office report.

The CBO report examines the structure and design components that would be needed for a single payer health system in the US. The report is worth a read as it highlights a bevy of moving parts and an analysis of costs and returns.

According to the CBO, IT system design and implementation would be a linchpin to any single payer healthcare model, because it would be key to coordinating care and holding down costs. The IT money statement in the CBO report goes like this:

Under the current U.S. health care system, with its fragmented payment and delivery systems, coordination of care is difficult, and a comprehensive review of care is challenging because no centralized utilization database exists. A single-payer system that collected comprehensive data on patients' use of health care services could potentially manage available resources more efficiently. But the transition to a standardized IT system across all providers would require considerable efforts, such as reaching a consensus for a standard among stakeholders, enforcing that standard, and addressing privacy issues related to data sharing.

In other words, standards, data management, and patient privacy would be major discussion points before any implementation. The healthcare market currently has adopted electronic medical records to a large degree, but interoperability between health systems is an issue. Meanwhile, the Federal government has also had numerous IT challenges with its Department of Veterans Affairs health system (see latest Government Accountability Office report), and Medicare has had its data and IT challenges amid larger issues.

The CBO noted in its report that in the US public programs haven't employed utilization management technology, but private insurers have lowered costs with those systems. The CBO noted:

Other countries with single-payer systems also use various forms of utilization management. In Canada's single-payer system, some provinces make lower payments to specialists when a patient has not been referred by a primary care physician. In England, access to specialists generally requires a referral from a primary care provider. Taiwan monitors use of services and costs in near-real time through its IT system to identify wasteful spending and inappropriate care.

Taiwan pops up as an example often in the CBO report as does the UK's National Health System, which has been extensively covered by ZDNet. (See: Fighting diseases with data science: How the NHS wants to smash silos to supercharge healthcare)

For instance, the CBO said that Taiwan has one robust IT system:

Taiwan's single-payer program has a robust IT system. Participants have National Health Insurance cards that store personal information, including recent visits to health care providers, diagnoses, and prescriptions. Providers must report all services delivered to patients each day to the National Health Insurance Administration, which tracks use of services and costs in near-real time. Other IT initiatives in Taiwan track patients' medical history and monitor prescription drugs.

What's unclear is whether cloud systems connected via application programming interfaces could ease a transition for a single payer health system. However, it's worth noting that the US government hasn't been good at migrating to the cloud or shuttering data centers to save money.

In any case, a standardized IT system would be critical to any Medicare for All arrangement. The devil would naturally lie in the implementation details. CBO noted:

A standardized IT system could help a single-payer system coordinate patient care by implementing portable electronic medical records and reducing duplicated services. To achieve those potential benefits, the IT system would need to accommodate all types of providers, particularly those in small practices or rural areas, and address compatibility issues between existing electronic medical records systems. Establishing an interoperable IT system under a single-payer system would have many of the same challenges as establishing an interoperable IT system in the current health care system with its many different providers and vendors. The IT system would also need to overcome the challenges of interfacing across multiple state and federal agencies. 

WHAT THE US CAN LEARN FROM THE NHS AND DIGITAL HEALTHCARE