I would like to use this visit to the blog to call attention to a new article by Laurence Baker, Elliott Fisher and John Wennberg, published on the Health Affairs website a couple of weeks ago. The authors analyzed hospital use by chronically ill patients in California and found a wide variation of resource use across hospitals treating patients with similar characteristics. The authors suggest that understanding the variation presents an opportunity for significant savings in health care expenditures by reducing resource use at the most resource-intensive hospitals, particularly because there is some evidence (in this study and others) that systems using greater resources actually deliver lower quality care.
This new research reinforces a larger body of work documenting the inefficient overuse of certain services and calling for better alignment of incentives and local delivery system accountability for the cost and quality of care. (I’ve written about some of Fisher’s contributions before here.)
Cost control solutions such as increasing copayments in order to slow premium growth, as the Connector Authority is now considering, address short-term fiscal demands but are unlikely to have a great effect on costs and may hinder access. Taking on variation of the sort reported by Baker et al. might produce substantial rewards in both slowed costs and improved quality, but would challenge the status quo and, potentially, the status of some major health care players. (Blue Cross has taken a step in this direction with its recent contracting plan, but its voluntary nature will limit its reach, and it is only one payer, albeit an important one.) The challenge is this: can we contain the growth of health care spending in Massachusetts to the degree needed without a fundamental restructuring of the delivery system and the incentives that drive it? And what institutions will move us in the direction we need to go?
Robert Seifert is a Senior Associate in the Center for Health Law and Economics at UMass Medical School’s Commonwealth Medicine, and is a member of the Massachusetts Health Care Quality and Cost Council.
Cost control, copayments, chronic illness management, really now, this is merely more dancing around the elephant in the parlor – until the very last sentence of this post:
“…And what institutions will move us in the direction we need to go?”
Well, one thing we can say for certain is that it’s not going to be any of the major players who brought us the Chapter 58 debacle. The sooner the better this wasteful house of cards is allowed to fall. We can say “Hey, we tried it as an experiment and discovered it’s not the solution that will work, so we’re doing something else now”.
Only when the state backs away from the flawed and failing individual mandate with its tax penalties for being uninsured and its wasteful Connector Contraption can we undertake real health system reform that puts people before profits and gets everybody covered with equal access to quality affordable healthcare. We have an obligation to achieve this without unfair cost-shifting to the poor and moderate income residents and without wasting huge sums of taxpayer dollars.
About Chapter 58. Yes, it’s good that more low income residents are covered now than before but it’s not good (in fact it’s very very bad) if the public financing is done is such a wasteful manner that the entire “reform” is not affordable nor sustainable. Add to that the fact that the new law uses an inherently flawed and harmful individual mandate, and we know for sure what institutions NOT to look toward for additional “reforms”, if we want health system improvements that address the causes of the problems and will actually work for the long term.
For solutions and leadership we must look to ourselves as active participants in a democracy and to our elected officials on the local, state, and national levels who are charged with carrying out public policymaking. We must identify and support public leaders who will put constituents’ interests above the interests of CEOs and corporate profit-making — this includes the corporate “nonprofits” like MA BCBS and Partners HealthCare that make hundreds of Million$$ in profits but get away with calling it “surplus” and being subsidized by taxpayers.
To lead the way on the state level we have Steve Tolman, Frank Hynes, Jamie Eldridge, and Patricia Jehlen and a growing number of other smart and brave legislators. They each support the health reform legislative package that the League of Women Voters, Mass-Care, and many other groups in MA enthusiastically endorse. This reform package includes Senate Bill 705, The MA Health Care Trust. This bill will establish a streamlined statewide nonprofit health care program to guarantee affordable, equitably-financed, and quality health care for all and does it without major increases in health spending.
On the national level it seems plausible that Senator Obama understands the pieces of health policy that will move us toward the ultimate goal of an expanded and improved Medicare-for-all program that will have the ability to implement best practice chronic illness management, health promotion and disease prevention, and other cost control measures related to reduced bureaucracy and stringent QA programs and oversight. These measures are impossible to effectively implement now due to the extremely fragmented and profit-driven nature of our non-system.
Private health insurance companies represent a large cause of the problem so they are certainly not the “institutions [that] will move us in the direction we need to go”. Whoever tries to convince you of that probably has a bridge in Brooklyn that they’d like to sell you, too…
Yes, we’ll likely see a few of the private insurers stick around and fight for customers in a supplemental coverage market; that’s the extent of insurance companies purpose for existence if the reform goal we’re working toward is quality affordable health care for all.
The government caused the entire problem with health care in America by over socializing (with unfunded mandates) medicine to the extent it is not completive. The government allows a monopolistic pharmaceutical environment, and the FDA a federal agency failing American citizens and needs be eliminated or completely re-organized; it’s corrupt, and is causing a major impact on the cost of healthcare in America, and we want to exacerbate the problem? http://www.InteliOrg.com/
FYI “Dr Coles” is something of a blog troll who lurks around dropping comments into posts as a way to push his conservative ideology of “the free market will take care of everything”…
Takes one to know one, Ann.
[...] here are do we have the political will to “mandate” price controls and other reform strategies (GETTING TO SOME CAUSES OF HEALTH CARE COSTS by Robert Seifert) as we have done with coverage? And are we willing to penalize those that do not [...]