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Value Based Healthcare

The state of US healthcare concerns us all. The rising costs are the principal concern and many of us wonder why do we spend more than other industrialized nations.  Leaving aside the assertion that the “other industrialized nations” provide the same level of care, the rising costs are definitely a problem. 

Many “sophisticated” schemes were (and are) tried – from the “gatekeeper” primary care provider in HMO to a “value based” or “accountable” healthcare organizations – those practicing “evidence-based medicine” and “patient centric approach” – the costs continue increasing. 

Personal Disclosure: I was always looking for “value” in medicine provided by “accountable” provider using “evidence-based medicine”. Who are these providers that deliver no “value”, are not “accountable”, and practice medicine that is not “evidence based”?  I was also never looking for unreliable car or unsafe food. Just for the record.   

What Fuels the Excessive Growth of Healthcare Costs?

  • First, cost/benefit considerations are absent. The presence of third-party coverage usually means that if the patient makes a decision, it is at best based on copay amount only. 
  • Second, the growth of administrative effort dedicated to search for “value” is competing with the effort of caring for patients for the “healthcare” spending.  It is possible that a substantial part of this administrative effort is focused on developing statistics that show its effectiveness.
  • Third, imposition of industrial thinking on an organic system is risky at least. It assumes more understanding than is warranted by our present state of knowledge. Measuring outcomes is quite complex and our means to do so are still crude – just think about using the number of re-admissions as a measure of quality. 
  • Many assert that the government managed single payer is the best solution.  We are told that such arrangements provide good healthcare and save money.  First, what the “good healthcare” term is malleable – you may want to check the US waiting times for health service and compare them with the waiting times in Canada.  Second, the argument that having more government involvement “saves money” is (hopefully) absurd at its face.  

    Unless we recognize that the re-introduction of free market driven medicine is the only way to efficiency and lower costs, quality, and expanded availability, the current search for “value”, “accountable”, “patient centric”, and “evidence based” health care will only keep increasing the administrative load on providers until they have no more time to care for the patients.

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