Why Even Good Hospitals And Doctors Are An Obstacle To Better, Cheaper Healthcare
from the perverse-incentives dept
As we noted in the context of antibiotics, it's well recognized that financial incentives cause the pharmaceutical industry to engage in research that tends to maximize profits rather than maximizing the health of the public. But a widely-circulated article in the Washington Post reveals another kind of bias that may stop us from adopting better ways of keeping people healthy that would also reduce healthcare costs.
This flows from the fact that countries with advanced healthcare systems are no longer dealing mainly with infectious diseases like turberculosis, as they once did, but with chronic ones like heart disease, diabetes, AIDS and many cancers. The key here is how best to manage the disease, particularly among elderly patients, and for that, doctors in hospitals aren't necessarily the best way:
Medicine has been so focused on what doctors can do in the hospital that it has barely even begun to figure out what can be done in the home. But the home is where elderly patients spend most of their time. It's where they take their medicine and eat their meals, and it's where they fall into funks and trip over the corner of the carpet. It's where a trained medical professional can see a bad turn before it turns into a catastrophe. Medicine, however, has been reluctant to intrude into homes.
One company, Health Quality Partners, has focused on doing precisely that:
The program enrolls Medicare patients with at least one chronic illness and one hospitalization in the past year. It then sends a trained nurse to see them every week, or every month, whether they're healthy or sick. It sounds simple and, in a way, it is. But simple things can be revolutionary.
The results certainly are:
According to an independent analysis by the consulting firm Mathematica, HQP has reduced hospitalizations by 33 percent and cut Medicare costs by 22 percent.
And yet Medicare is planning to shelve this pilot program, citing various bureaucratic reasons why it can't continue. Although some supporters of the home-based system maintain that it would be possible to overcome these problems, there remains a more fundamental obstacle to rolling out the Health Quality Partners approach more widely:
Hospitals make money when they do more to patients. They lose money when their beds are empty. Put simply, Health Quality Partners makes hospitals lose money.
So again we seem to be confronted by perverse incentives at the heart of our current healthcare. The better and cheaper way would mean scaling back key parts of the system by instituting regular home visits by nurses, thus reducing the number people sent into hospitals to be treated by physicians. That implies taking on very profitable and thus very powerful business interests, including the doctors themselves. Given that resistance, and Medicare's apparent reluctance to force change by backing the Health Quality Partners system, it seems likely that we will be stuck with an inferior, more costly approach to treating chronic diseases despite knowing what looks like a much better way to do it. Some might call that pretty sick.
Follow me @glynmoody on Twitter or identi.ca, and on Google+
![Hide This Hide this](https://ii.techdirt.com/s/t/i/topclose.png)
Thank you for reading this Techdirt post. With so many things competing for everyone’s attention these days, we really appreciate you giving us your time. We work hard every day to put quality content out there for our community.
Techdirt is one of the few remaining truly independent media outlets. We do not have a giant corporation behind us, and we rely heavily on our community to support us, in an age when advertisers are increasingly uninterested in sponsoring small, independent sites — especially a site like ours that is unwilling to pull punches in its reporting and analysis.
While other websites have resorted to paywalls, registration requirements, and increasingly annoying/intrusive advertising, we have always kept Techdirt open and available to anyone. But in order to continue doing so, we need your support. We offer a variety of ways for our readers to support us, from direct donations to special subscriptions and cool merchandise — and every little bit helps. Thank you.
–The Techdirt Team
Filed Under: economics, healthcare, incentives
Reader Comments
Subscribe: RSS
View by: Time | Thread
Yes, there are illnesses and diseases that cannot be prevented; but lifestyle illnesses are easily preventable with effort.
Big pharma would never allow this, though, because they make too much under the current reactive healthcare systems.
[ link to this | view in thread ]
Wrong target. Medicare is insurance
Isn't Medicare an insurance program?
[ link to this | view in thread ]
Another reason the NHS is far superior toy our crog of shite!
We not only have home care provided by the local councils but we also have sets of nurses whose sole job it is too look after people in the community.
[ link to this | view in thread ]
Re:
[ link to this | view in thread ]
I'd probably be hurting pretty bad without it though lol.
[ link to this | view in thread ]
And hospitals make more money when they screw up
That was most definitely NOT something I wanted to read when I have open heart surgery scheduled next month.
[ link to this | view in thread ]
Re: Wrong target. Medicare is insurance
The operative word is "companies". There was a time at least in US history, when almost all medicine was non-profit. Of course, doctors did well, made good middle-class incomes, but all hospitals were non-profit.
You can trace the collapse of US health care to the Reagan Era, when health care insurance was deregulated and insurance companies started buying up hospitals. This "free market" innovation did nothing but cause prices to shoot skyward. Reagan always hated Medicare (which until then was keeping costs down) and sought the deregulation in order to destroy it. Instead, the whole system metastasized.
[ link to this | view in thread ]
Dr LaPierre calling...
While they're at it, they can keep pushing AGW denialism, so more extreme weather will harm more people too. I'm just surprised the Big Medicine conspiracy isn't pushing Romneycare so that more people can 'afford' their tender mercies?
AS usual, I am thankful for living in my 'socialist heaven' that is the Tory wasteland I inhabit.
[ link to this | view in thread ]
Setting the record straight.
One might think that this one size fits all deal is great, but one has to look at the full story behind the recent IRS scandal to see it doesn't work.
[ link to this | view in thread ]
Re: Re: Wrong target. Medicare is insurance
The reason why the cost is so high is that Doctors have to pay the safety measures of runnning nuclear equipment, malpractice insurance, not buying packets of medications in bulk (mainly because each order is custom made for a patient's matabolism and specific body chemistry), and for generally the inherent risk of working in a hospital...which includes but is not limited to Biogazzard risks, potential radiation exposure ove time, the doctor has to cover the malpractice insurance based on the staff in his charge...so yeah the expense is very justified.
[ link to this | view in thread ]
Re:
I guess we should all be able to treat our own gun shot wounds, automatically know what it means and how to treat a disease when it involves coughing up blood (Tuberculosis for those who don't know), diagnose and self medicate.
The reason why humans need educated doctors to tell us what's going on is that it prevents bias and generally helps us treat ourselves on our own in general. We here in the US and UK usually visit a doctor when a cold or flu starts becoming painful, or when it lasts for 3 weeks. So I'm sorry that some of you from other countries don't understand the danger of self diagnosis.
[ link to this | view in thread ]
[ link to this | view in thread ]
Re: Re:
[ link to this | view in thread ]
Re: Re: Wrong target. Medicare is insurance
/boggle
[ link to this | view in thread ]
Re:
[ link to this | view in thread ]
Re: Re: Re:
[ link to this | view in thread ]
See, for instance, Dr. Phil being unable to even refer you to a specialist because he's not licensed and so you can't see a specialist without first going to a licensed generalist. You can't even see a physical therapist without first getting a referral by a general practitioner and when your physical therapy session is up and you want to see the physical therapist again you must get another referral and pay even more money.
Lets not forget the fact that, here in the U.S., most everything is under prescription and so you need a prescription for so many drugs that are over the counter in other countries. This makes access to basic medications much more expensive.
[ link to this | view in thread ]
Re: Re: Re:
So here's the thing. When you are talking about Lifestyle diseases....it makes you sound like a sort of jerk to those of us in the US and UK. A lot of very discriminating very biased people use that term to define AIDS as if it were a lifestyle choice to get it. It is assassinated with homophobia or a coplete lack of knowledge in the basic medical knowledge other countries and their citizens have compared to the US and UK...and trust me...we aren't going to the doctor unless it is persistent and feels abnormal.
[ link to this | view in thread ]
Re:
[ link to this | view in thread ]
Source: Myself, I support these Aides.
[ link to this | view in thread ]
The issue here is overprescription
[ link to this | view in thread ]
Re: The issue here is overprescription
[ link to this | view in thread ]
Re: The issue here is overprescription
[ link to this | view in thread ]
Re: Wrong target. Medicare is insurance
[ link to this | view in thread ]
Re: Re: Re: Re:
[ link to this | view in thread ]
Re: Re: The issue here is overprescription
[ link to this | view in thread ]