It seems to me…
“No one should have to choose between medicine and other necessities. No one should have to use the emergency room every time a child gets sick. And no one should have to live in constant fear that a medical problem will become a financial crisis.” ~ Brad Henry.
Like it or not, death whether it results from violence, accidents, infectious disease, or a wide range of other causes, is inevitable. The primary causes of death in the U.S. in 1900 were pneumonia/influenza, tuberculosis, and gastrointestinal infections. Today, they are heart disease and cancer. Although the U.S. has the most expensive health care system in the developed world, the nation ranks lowest in terms of “efficiency, equity, and outcomes”[i].
There are many reasons for high healthcare costs. One reasons is that economically disadvantaged people without medical insurance postpone needed health care until their condition becomes sufficiently serious that it no longer can be ignored and, as a result, has become much more expensive to treat. While undocumented immigrants (so-called “illegals”) are part of this problem, they statistically are not the highest percentage of individuals affecting healthcare costs. Anyone suffering from a serious illness, regardless of whom or what they might be, should receive medical attention in order to reduce an infectious illness’ possible effect on the general population. Everyone, regardless of their legal stature, should be required to have some form of medical/healthcare insurance.
As for providing assistance to those in need: seniors, homeless, orphans, veterans…, part of the current budget debate in Congress is over Republican attempts to further reduce assistance while Democrats are trying to preserve those benefits that most people already consider insufficient. The Affordable Care Act (ACA), while an improvement, in its present form is insufficient to resolve this problem.
Requesting patients to make market decisions about healthcare, as advocated by many conservatives, is not only ill advised but in many ways cruel and unnecessary. Changing the way healthcare is provided rather than the way it is sold is the most efficient way to reduce expenditures.
About 33 percent of Americans receive health care from organizations similar to the Geisinger health care system, considered by many healthcare authorities to be a model to reduce expenditures and provide improved care, where doctors are paid salaries and outcome-based performance bonuses rather than by the services they perform. Doctor’s bonuses depend upon how closely they adhere to Geisinger’s routine procedures and patient rating of their doctors and care. Assigning a case manager providing individual attention to chronic care cases produces improved results. An American Journal of Medical Quality study found the Geisinger resulted in 18 percent fewer hospital visits, 36 percent less return visits, and 7 percent cost savings[ii].
Fee-for-service Medicare frequently results in unnecessary procedures and increased expenditures. Probably about 40 percent of the care provided by doctors and hospitals is not appropriate. The medical profession, mostly with the best intent and in response to the threat of malpractice suits, undeniably benefits financially from fee-for-service. The majority of doctors are opposed to the Mayo-Geisinger business model, favor the freedom of fee-for-service, and object to constant scrutiny by their peers.
For better or worse, a new generation of medical data gathering and diagnostic devices are being developed including smartphone-enabled ultrasound machines, portable glucose monitors, and handheld electrocardiogram devices[iii]. While these devices will not qualify for consideration by the X Prize Foundation for its $10 million prize for the creation of a Star Trek medical tricorder device capable of diagnosing fifteen common diseases such as diabetes, pneumonia, and tuberculosis, sensors are becoming smaller and less expensive making such a device feasible.
While beneficial, especially in areas with a shortage of qualified medical practitioners and rising healthcare costs, the downside of ready availability of these types of medical devices is the tendency for people to self-diagnose and medicate. These types of devices pose a potential disruption to the medical economy and the medical profession can be expected to challenge unrestricted device marketing. Still, emergence of handheld medical technologies could transform medical information dissemination shifting increasing amounts of data to patients.
Digital technology has the potential to revolutionize the healthcare system. Smartphones and other healthcentric devices can monitor heart rate, activity level, sleep quality, and other personal measurements, and then display that data in easy to read graphs or transmit it to a patient’s healthcare provider. Much additional development is necessary. While devices will be capable of collecting significantly greater amounts of data in the future, especially when the Internet of Things[iv] (IoT) is more widely available, the amount of data potentially available could overwhelm both the individual and medical staff unless improved applications to analyze and display results are developed.
That’s what I think, what about you?
[i] From a 2014 Commonwealth Fund survey.
[ii] Klein, Joe. The Long Goodbye, Time, 11 June 2012, pp18-25.
[iii] Wright, Alex. Patient, Heal Thyself, Communications of the ACM, August 2013, pp16-18.
[iv] Bornmann, PhD, Lewis J. Internet of Things, https://lewbornmann.wordpress.com/2013/12/10/internet-of-things/, 10 December 2013.