When all the shouting is about the health crisis in the United States, many difficulties are likely to focus, let alone understand the problems in September. I understand that the tone of the debate stirred (although I understand that --- people are afraid), and someone's got trouble enough qualified on the best way to improve health care system as it is only to know when people who spent a career studying it (I do not mean the politicians) are not sure what to do with myself.
Albert Einstein had a reputation for saying that if he had an hour to save the world, he spent 55 minutes on problem definition, and only five minutes to go. Our health system is much more complex than most, offers solutions to accept or recognize, and if we focus most of our efforts to determine their problems and understand the reasons for any change we can do for t 'made them worse, because it is better.
Even though I worked in the American health care system as a doctor since 1992 and has seven years experience as CEO of PHC available, I consider myself qualified to accurately assess the sustainability of the improved health Ive heard suggestions. But I think I can at least take part in the discussion by describing some of their problems, which are reasonable assumptions in its causes, and a summary of some general principles to be applied to their problems.
The issue of costs Nobody disputes that health costs in the United States is rapidly increasing. According to the Centers for Medicare and Medicaid Services (CMS), health spending is estimated fell $ 8.160 per person per year by the end of 2009 compared to $ 356 per person per year in 1970. This increase was about 2.4% faster than GDP growth during the same period. Although GDP varies throughout the year and a year and then answer the new health care costs compared with other costs from one year to plan, you may not have these figures yet 40 years as a percentage The gross domestic product (personal, corporate and government), we have increased spending on health.
Despite what most expected, it can not be good. Everything depends on two things: why health resources in relation to our gross domestic product grew, and how much value we get for every dollar they spend. WHY HEALTH become so expensive? It's hard to answer a question than many would guess the answer. Increased health care (an average of 8.1% annually from 1970 to 2009 data calculated above) has exceeded inflation (4.4% on average during the same period), so we can not grow, and costs Inflation and call. Expenditures on health is known to closely monitor the gross domestic product of the country (a prosperous nation, for medical purposes), but the United States is still no response (Figure 3).
Is this because of the cost of health care for 75 elderly people (five times what we spent on people aged 25 and 34)? In a word, no. Research shows that demographics explain only a small percentage of growth in health costs.
And terrifying health insurers are making profits? Probably not. And in any case difficult to know for sure, because all insurance companies are publicly traded and therefore budgets are available for public review. Aetna, but one of the largest publicly traded health insurance companies in North America, reported 2009 second-quarter profit of $ 346,700,000, which, as projected, providing an annual profit of around 1.3 billion dollars , about 19 million people entered. If we assume the average profit margin in this industry (even if true, is probably an order of magnitude different from the average), the overall results for all private health insurers in America, which has 202,000. 000 people (second item on the list) in 2007, will be about 13 billion dollars a year. Total health spending in 2007 was 2.2 trillion (see Table 1 on page 3) a private benefit to the health of 0.6% of total health spending (although that mixture analysis of data from different years, it may qualify as figures are probably no different from an order of magnitude).
Is health care fraud? Fraud loss estimates range as high as 10% of total health spending, but it is difficult to provide reliable data to support this thesis to find. Although a certain percentage of fraud is discovered, perhaps, perhaps the best way to determine how much money lost to fraud the government actually collected. In 2006 was $ 2,200,000, only 0.1% to 2.1 billion dollars (see Table 1 on page 3) of the total health care spending that year.
Is this because of the cost of pharmaceuticals? In 2006, total spending on prescription drugs, over U.S. $ 216,000,000,000 (see Table 2, page 4). Although they represent 10% of 2.1 trillion dollars (see Table 1 on page 3) Total expenditure on health care this year and is considered essential, is only a small percentage of total health expenditure.
And administrative costs? In 1999, total administrative costs estimated at 294 billion dollars, 25% of the total 1.2 trillion dollars (Table 1) of the total health care spending that year. This was an important part in 1999, and it's hard to believe, sitting in a significant amount since then. Ultimately, however, which is probably most affected by increasing the amount of health spending in the U.S. are two things: 1 Thanks to new technology. 2. Over-use of health care resources, patients and their caregivers.
technological innovation. The data indicate that increased health care costs primarily due to technological innovation is surprisingly difficult to obtain, but estimates of the contribution of the rising cost of health care due to the field of technology innovation that will be of 40 % to 65% (Table 2, page 8). Although most empirical data available for this purpose, some examples to illustrate this principle. Heart attacks are treated with aspirin and prayers. Now she is treated with medicine from the shock, pulmonary edema and arrhythmias, as well as thrombolytic therapy, cardiac catheterization with angioplasty or grafting, and bypass surgery to control. You do not need an economist scenario that ends are more expensive to use.
You can learn how to do the same procedure with a lower cost of time (as we figured out how to make computers cheaper), but because the price of procedures to reduce the total amount spent for each procedure, increases as the number of procedures performed increases. Laparoscopic cholecystectomy was 25% lower than the price of an open cholecystectomy, but prices of both have increased by 60%. As a result of technological development will be more widely used, they are more commonly used, and what we're doing good technology.Overuse U.S. health care resources, patients and caregivers themselves. We can easily define as overuse of unnecessary health care resources. What is not so easy to recognize. Every year in October to February, the majority of patients coming to hospital emergency surgery so I think it is vain. What do they do? Colds. I can help to ensure that there is nothing seriously wrong offer, and advice on drugs, over-the-counter --- but none of these things will not improve soon (although they are often able to reduce worry).
) Addition., Patients find it difficult to believe that the key to achieving a correct diagnosis is the history of physical examination and analysis, rather than technology-based (not that it has developed important --- just under the majority of patients do not ). What is excessive use of patient-based health system is difficult to understand, because we usually only anecdotal evidence as above.
Furthermore, doctors often differ among themselves about what is needed for health care form. In his excellent article, the cost conundrum "," Atul Gawande argued that regional differences in over-use of health by doctors more aware of regional variation in Medicare spending per person. He continues that if doctors can use zones to encourage a high cost country to increase, it would be sufficient for its Medicare money for 50 years of solvency to maintain the stores.
A reasonable approach. For this purpose, but we must understand why doctors overutilizing health care resources, with emphasis on the following: 1. limits of discretion within which literature is ambiguous or irrelevant. When faced with dilemmas of diagnosis or condition for which treatment standards are not set, a change in practice still occurs. If the doctor suspects the patient has a wound, it is empirical or consult a gastroenterologist for an endoscopy? If some "red flag" symptoms are present, most doctors refer. If it is not safe and not in accordance with their training and exercise stop immaterial.
2 inexperience or lack of contrast. More experienced physicians tend to rely on stories and medical examinations that less experienced physicians, and thus less testing and lower costs. Studies show that less money on AP tests and procedures as Vice colleagues, but are equal and sometimes even better results. The third fear of persecution. This is especially common in emergency rooms, but covers almost all areas of medicine. Patients tend to be managed to claim fourth on rather less. As mentioned above. And doctors often find it difficult to express the desire of patients for various reasons, refuse (for example, you, for fear of missing a diagnosis and be sued, etc.).
5. In many cases, doctors make excessive use of money. There is no reliable way to encourage doctors to spend their limited or capitated if their salaries directly from wages. Gawande article implies, there is a use of healthcare resources in the best possible use very little and you get errors and missed diagnoses, use more and more money to spend without the results to improve, sometimes, paradoxically, leads to results that actually make things worse (maybe all the complications of additional testing and treatment). How do doctors always a good deed to use, so that the correct number of patient treatment and testing for all --- "sweet spot" --- in order to get the best results with risk little to no complications? It is not easy. This is, fortunately or unfortunately, is a good use of healthcare resources. Some doctors are so talented than others. Some are more diligent maintenance. Some more patient care. Explosion studies of medical tests and treatments are carried out in recent decades to help doctors choose the most efficient, safer and even cheaper ways of medicine, but here the dissemination of evidence-based medicine is a complex job. The fact that beta-blocker, for example, has been shown to improve survival after a heart attack, or offer any doctor I know. The data clearly show that many of them do not. As is common in medical literature information in medical practice is a topic worthy of a post all its own. As it is still very difficult.
In summary, the majority of increased spending for health care technological innovations associated with abuse by physicians who work in systems that motivate them to practice more to have in place to improve the drug and patients who felt that the claim older than latter.But return even if we can snap your fingers and now removed all the excessive use of health care today in the United States will remain the most expensive in the world, we should seek after --- What Dollars can see opportunity pass? According to the article in the New England Journal of Medicine has the burden of health costs for working families --- implications for the reform of health care expenditure growth "can be defined as affordable as long as the percentage increase in revenue and reduces health living.When standard of absolute growth in revenue can not follow the absolute increase in medical costs, increased health care may be paid only by sacrificing consumption of goods and services unrelated to health care. "If this is an acceptable situation would be? Only when the additional cost of health care buyers, or a higher marginal value. For example, if you know you are in the near future that will use 60% of your income on health, but because you want, chance, for example, 30% of age250 life, a judge Better than 60% a small price to pay. It seems that the debate over health care costs should be about. Surely we should work on ways to prevent overfishing But the real problem is not the absolute amount of money. is much to be spent on health care. The real question is what we get for the money they spend is valuable and we should resign?
People are concerned about the idea that health care costs rise, because policymakers may decide to ration health care do not realize that we are already limited, at least a part of it. It seems that because we are limiting the first come, first serve basis --- at least in part, left to chance, or even a policy that we are uncomfortable with the definition and implementation. Therefore we do not understand why 90 years in Illinois is not the father may be a need to offer, as the daughter of 14 years, Alaska is at the forefront (or perhaps we have responded to his father to get money and girls was 14 it is not). Due to the fact that most of us are uncomfortable with the idea of limiting health care for reasons such as age, or Thurs services, technological innovation continues to drive the cost of health care for me very well at some point in May and criticism The judge in medical innovation for the community access to goods and other services will be provided (if they are so foolish as the problem of believing that you can keep borrowing money is not repeated again).
So what is the value that we have come? It varies. Risk of dying from a heart attack decreases by 66% since 1950 due to technological innovation. cardiovascular disease in the ranks of a number of cause of death in the United States, this seems a high value on a scale that a benefit has the right part of the population in important ways. Since the development of pharmacology, we are now able to treat depression, anxiety and even psychosis, much better than we first imagined between 1980 (when Prozac was first published). Obviously, an increase in healthcare costs of critical importance, we want to give.
But how can we decide whether the novelty value? research shows that innovation (if proper care) was a significant clinical benefit (Aricept is a good example of a drug that works, but there is little clinical benefit in patients with dementia tests --- the sound of cognitive skills, the All but unlikely to be significantly more functional and better remember their children when they are not). However, comparative studies on the effectiveness of long duration to complete, and can not be fully implemented for each patient, this means that some health care providers is to always use common sense and problems of medical patients.
Who is best placed to assess the value to the community for the benefit of an innovation --- that is, to determine whether the benefits of innovation greater than the costs? I would say that the group paid at the end: the American public. How to reconcile public opinion and communicate effectively with policy makers effective enough to influence current policy, but also extends beyond the scope of this position (and maybe the imagination of a person).
The problem of access to a large proportion of the population is uninsured or underinsured, to reduce or eliminate their access to health care. Therefore, this group is the path of least (and resistance to the cheapest rooms) --- --- trouble is significantly weakened the ability of ER doctors in our country to the attention needs to reach in time. In addition, records indicate a looming shortage of primary care physicians compared with demand for their services. I believe that this imbalance between supply and demand explain the poor customer service to patients in comparison with our system every day waiting periods for medical appointments, long waiting times at doctors 39; office after his appointment the day , short-term doctors in exam rooms, followed by difficulties in reaching their physicians between visits, and ultimately delays in receiving test results. This imbalance is probably only partially mitigated by the use of lower health care by patients.
GUIDELINES solution, as the authors Steven Levitt and Stephen Dubner Freaknomics state, "If morality is what people want the world to work, the economy is how it really works" Capitalism is based on the principle of enlightened self-interest a system. This encourages conduct that would bring benefits to both suppliers and customers and the community as a whole. But when incentives go haywire, people start to do the best to go often to the detriment of others or even their spending on the road. Despite the changes that make our health system (and there are always more than one way to skin a cat), we must be sure to include incentives for behavior that results in any part of the system contribute on its stability in the country for a concern.
Here is a summary of what I think the best recommendations come along for the problems I described above: one to solve. Changing insurance companies way of thinking to do business. insurance companies have the same purpose as any other business: maximize profits. And if a health insurer is publicly traded in his 401k portfolio, you want to increase benefits, too. Unfortunately, the best way for them to do is to refuse its services to customers more for their pay. It's hard to risk (the function of an insurance company for distribution), compared to say, car insurance, because people are too moreinsurance stated that car insurance claims. Therefore, it seems, from the perspective of consumers, private health insurance model is wrong. We need a barrier to health insurance claims (or the opposite, an additional incentive for them to pay for denied making). Allow and encourage competition, Aaro State security is at least partly relevant to the market forces to drive down insurance premiums and new markets for local insurance companies for the benefit of insurance consumers and suppliers. their customers are now armed with the might of interest to see elsewhereInsurance companies can get the quality they actually provide services to their clients (for example, payment of claims), as a way to preserve and grow their businesses to watch. For it to work, monopolies or semi-monopolies to be abolished, or at least discouraged. Although this works, but the public probably still rules health insurance for some of the worst atrocities have taken place to stop growing (for example, insurers must notallowed customers to stratify into subgroups by age and by increasing the risk premiums old high average disease group for health reasons older consumers ultimately punished for their age rather than their behavior). Karl Denninger suggests some interesting ideas in a post on his blog to require insurers to offer similar rates to businesses and individuals, as well as creating an obligation to "open enrollment" periods during which participants may choose either any plan annually. This will avoid people to get insurance when they became ill, which prevents the problem of adverse selection leading insurers are paying existing conditions decline. I would add that, regardless of reimbursement rates for health, health care depends on the future (once the whole post in itself), all health insurance plans, whether private or public, health professionals should turn in part equal, the link, "good" and "security is wrong, which is currently responsible for motivating hospitals and physicians to restrict or deny service to the poor and may be responsible for the same thing for future progress of the elderly (Medicare to pay a little better than Medicaid). Finally, because the idea of an option "public" insurance plan is open to all, I am afraid that if it is more cheaper than private alternatives, while nearly a benefit across the country in droves to ride the occupied private insurance companies and forcing everyone to support each other with higher taxes and less health care decisions, but at the same time as the cost to consumers of "public choice" is comparable with the private alternative will be if not many people can not afford it.
2. Motivating people to healthy lifestyle, which indicated to prevent the disease continued. Prevention of disease is likely to save money, although some have said, adds to the life chances of developing diseases that would otherwise have occurred, and the overall health care system dollars (even if it's true year of life should be considered more valuable enough additional cost. In the end, so that all of improving the quality of health care and the number of life save the company money, let's not put the cart before that) .. But the idea of preventing a possible bad outcome in the future is just as bad psychologically motivate many people have so many problems, exercise, eat well, lose weight, stop smoking, etc. The idea of rewarding the desired behavior , financial and / or financial punish undesirable behavior is highly controversial. Even though I am afraid that this kind of risk strategy for the implementation of policies that undermined the fundamental freedoms or take, I'm not opposed to creative thinking about how our forces can use strong motivation to help people achieve health goals that they want to achieve. Ultimately, most overweight people lose weight. Most smokers want to quit smoking. They may be more effective than they could find more powerful motivation.
Over-third of health care falls by doctors. I understand Gawande way for doctors to stop overutilizing health care resources available is a laudable goal, which would be a considerable expense cage store will require a willingness to experiment and it will take time. And I agree that focus only on who should pay for our health (public or private) will not issue enough. But exactly how to encourage doctors, whose feathers are responsible for most of the money spent on health care rather than focus on what is really best for their patients? The idea that foreign agencies or government insurers --- --- panels can be used for medical care standards to determine the most ridiculous track costs to manage. These organizations have no training or major concern for patients social needs can be trusted to make such decisions. Why else would we have doctors, if not used their skills gradient methods to be applied in complex situations? By modus operandi of the incentives system is free to compete with their obligations to their patients to stay in position better decisions about what tests and treatments are available, giving attention to the patient, while careful not to ensure the protection of himself (by refusing to take the head CT can be a headache thrills paternalistic, refusing to give chemotherapy is not hot) to be. Maybe we should eliminate financial incentives for doctors to worry about anything, but the benefit of patients, which means that doctors' salaries must be cut off from the number of apartments have been conducted and the number of controls to rule, and instead determined by market forces. This model exists in the University health care and do not look poor quality care when doctors feel fairly rewarded to encourage. Doctors should have a good life in order to compensate for years of training and large amounts of accumulated debt, but there is more financial incentive to practice medicine should be given the right to life insurance.
4. Reduce excessive use of healthcare resources by patients. This, I think we need at least three things: * provide adequate resources for legal problems (so that patients go to the trouble to colds, for example, but instead their physician primary care). This will be the "sweet spot" touch on the number of primary care physicians better control of access to primary care, not a matter of health care as the old model HMO, and selection and treatment. It will also require a recalculation of the compensation levels for primary care services with specialized services to encourage medical students to go into primary care (to stop the disturbing trend, in the last ten years.)
* A massive effort in public health education to improve its capacity of solving their problems (increased so that patients do not really anywhere to go for a cold or ask for an MRI on his back when your doctor Tell them that faith is only one race).
Albert Einstein had a reputation for saying that if he had an hour to save the world, he spent 55 minutes on problem definition, and only five minutes to go. Our health system is much more complex than most, offers solutions to accept or recognize, and if we focus most of our efforts to determine their problems and understand the reasons for any change we can do for t 'made them worse, because it is better.
Even though I worked in the American health care system as a doctor since 1992 and has seven years experience as CEO of PHC available, I consider myself qualified to accurately assess the sustainability of the improved health Ive heard suggestions. But I think I can at least take part in the discussion by describing some of their problems, which are reasonable assumptions in its causes, and a summary of some general principles to be applied to their problems.
The issue of costs Nobody disputes that health costs in the United States is rapidly increasing. According to the Centers for Medicare and Medicaid Services (CMS), health spending is estimated fell $ 8.160 per person per year by the end of 2009 compared to $ 356 per person per year in 1970. This increase was about 2.4% faster than GDP growth during the same period. Although GDP varies throughout the year and a year and then answer the new health care costs compared with other costs from one year to plan, you may not have these figures yet 40 years as a percentage The gross domestic product (personal, corporate and government), we have increased spending on health.
Despite what most expected, it can not be good. Everything depends on two things: why health resources in relation to our gross domestic product grew, and how much value we get for every dollar they spend. WHY HEALTH become so expensive? It's hard to answer a question than many would guess the answer. Increased health care (an average of 8.1% annually from 1970 to 2009 data calculated above) has exceeded inflation (4.4% on average during the same period), so we can not grow, and costs Inflation and call. Expenditures on health is known to closely monitor the gross domestic product of the country (a prosperous nation, for medical purposes), but the United States is still no response (Figure 3).
Is this because of the cost of health care for 75 elderly people (five times what we spent on people aged 25 and 34)? In a word, no. Research shows that demographics explain only a small percentage of growth in health costs.
And terrifying health insurers are making profits? Probably not. And in any case difficult to know for sure, because all insurance companies are publicly traded and therefore budgets are available for public review. Aetna, but one of the largest publicly traded health insurance companies in North America, reported 2009 second-quarter profit of $ 346,700,000, which, as projected, providing an annual profit of around 1.3 billion dollars , about 19 million people entered. If we assume the average profit margin in this industry (even if true, is probably an order of magnitude different from the average), the overall results for all private health insurers in America, which has 202,000. 000 people (second item on the list) in 2007, will be about 13 billion dollars a year. Total health spending in 2007 was 2.2 trillion (see Table 1 on page 3) a private benefit to the health of 0.6% of total health spending (although that mixture analysis of data from different years, it may qualify as figures are probably no different from an order of magnitude).
Is health care fraud? Fraud loss estimates range as high as 10% of total health spending, but it is difficult to provide reliable data to support this thesis to find. Although a certain percentage of fraud is discovered, perhaps, perhaps the best way to determine how much money lost to fraud the government actually collected. In 2006 was $ 2,200,000, only 0.1% to 2.1 billion dollars (see Table 1 on page 3) of the total health care spending that year.
Is this because of the cost of pharmaceuticals? In 2006, total spending on prescription drugs, over U.S. $ 216,000,000,000 (see Table 2, page 4). Although they represent 10% of 2.1 trillion dollars (see Table 1 on page 3) Total expenditure on health care this year and is considered essential, is only a small percentage of total health expenditure.
And administrative costs? In 1999, total administrative costs estimated at 294 billion dollars, 25% of the total 1.2 trillion dollars (Table 1) of the total health care spending that year. This was an important part in 1999, and it's hard to believe, sitting in a significant amount since then. Ultimately, however, which is probably most affected by increasing the amount of health spending in the U.S. are two things: 1 Thanks to new technology. 2. Over-use of health care resources, patients and their caregivers.
technological innovation. The data indicate that increased health care costs primarily due to technological innovation is surprisingly difficult to obtain, but estimates of the contribution of the rising cost of health care due to the field of technology innovation that will be of 40 % to 65% (Table 2, page 8). Although most empirical data available for this purpose, some examples to illustrate this principle. Heart attacks are treated with aspirin and prayers. Now she is treated with medicine from the shock, pulmonary edema and arrhythmias, as well as thrombolytic therapy, cardiac catheterization with angioplasty or grafting, and bypass surgery to control. You do not need an economist scenario that ends are more expensive to use.
You can learn how to do the same procedure with a lower cost of time (as we figured out how to make computers cheaper), but because the price of procedures to reduce the total amount spent for each procedure, increases as the number of procedures performed increases. Laparoscopic cholecystectomy was 25% lower than the price of an open cholecystectomy, but prices of both have increased by 60%. As a result of technological development will be more widely used, they are more commonly used, and what we're doing good technology.Overuse U.S. health care resources, patients and caregivers themselves. We can easily define as overuse of unnecessary health care resources. What is not so easy to recognize. Every year in October to February, the majority of patients coming to hospital emergency surgery so I think it is vain. What do they do? Colds. I can help to ensure that there is nothing seriously wrong offer, and advice on drugs, over-the-counter --- but none of these things will not improve soon (although they are often able to reduce worry).
) Addition., Patients find it difficult to believe that the key to achieving a correct diagnosis is the history of physical examination and analysis, rather than technology-based (not that it has developed important --- just under the majority of patients do not ). What is excessive use of patient-based health system is difficult to understand, because we usually only anecdotal evidence as above.
Furthermore, doctors often differ among themselves about what is needed for health care form. In his excellent article, the cost conundrum "," Atul Gawande argued that regional differences in over-use of health by doctors more aware of regional variation in Medicare spending per person. He continues that if doctors can use zones to encourage a high cost country to increase, it would be sufficient for its Medicare money for 50 years of solvency to maintain the stores.
A reasonable approach. For this purpose, but we must understand why doctors overutilizing health care resources, with emphasis on the following: 1. limits of discretion within which literature is ambiguous or irrelevant. When faced with dilemmas of diagnosis or condition for which treatment standards are not set, a change in practice still occurs. If the doctor suspects the patient has a wound, it is empirical or consult a gastroenterologist for an endoscopy? If some "red flag" symptoms are present, most doctors refer. If it is not safe and not in accordance with their training and exercise stop immaterial.
2 inexperience or lack of contrast. More experienced physicians tend to rely on stories and medical examinations that less experienced physicians, and thus less testing and lower costs. Studies show that less money on AP tests and procedures as Vice colleagues, but are equal and sometimes even better results. The third fear of persecution. This is especially common in emergency rooms, but covers almost all areas of medicine. Patients tend to be managed to claim fourth on rather less. As mentioned above. And doctors often find it difficult to express the desire of patients for various reasons, refuse (for example, you, for fear of missing a diagnosis and be sued, etc.).
5. In many cases, doctors make excessive use of money. There is no reliable way to encourage doctors to spend their limited or capitated if their salaries directly from wages. Gawande article implies, there is a use of healthcare resources in the best possible use very little and you get errors and missed diagnoses, use more and more money to spend without the results to improve, sometimes, paradoxically, leads to results that actually make things worse (maybe all the complications of additional testing and treatment). How do doctors always a good deed to use, so that the correct number of patient treatment and testing for all --- "sweet spot" --- in order to get the best results with risk little to no complications? It is not easy. This is, fortunately or unfortunately, is a good use of healthcare resources. Some doctors are so talented than others. Some are more diligent maintenance. Some more patient care. Explosion studies of medical tests and treatments are carried out in recent decades to help doctors choose the most efficient, safer and even cheaper ways of medicine, but here the dissemination of evidence-based medicine is a complex job. The fact that beta-blocker, for example, has been shown to improve survival after a heart attack, or offer any doctor I know. The data clearly show that many of them do not. As is common in medical literature information in medical practice is a topic worthy of a post all its own. As it is still very difficult.
In summary, the majority of increased spending for health care technological innovations associated with abuse by physicians who work in systems that motivate them to practice more to have in place to improve the drug and patients who felt that the claim older than latter.But return even if we can snap your fingers and now removed all the excessive use of health care today in the United States will remain the most expensive in the world, we should seek after --- What Dollars can see opportunity pass? According to the article in the New England Journal of Medicine has the burden of health costs for working families --- implications for the reform of health care expenditure growth "can be defined as affordable as long as the percentage increase in revenue and reduces health living.When standard of absolute growth in revenue can not follow the absolute increase in medical costs, increased health care may be paid only by sacrificing consumption of goods and services unrelated to health care. "If this is an acceptable situation would be? Only when the additional cost of health care buyers, or a higher marginal value. For example, if you know you are in the near future that will use 60% of your income on health, but because you want, chance, for example, 30% of age250 life, a judge Better than 60% a small price to pay. It seems that the debate over health care costs should be about. Surely we should work on ways to prevent overfishing But the real problem is not the absolute amount of money. is much to be spent on health care. The real question is what we get for the money they spend is valuable and we should resign?
People are concerned about the idea that health care costs rise, because policymakers may decide to ration health care do not realize that we are already limited, at least a part of it. It seems that because we are limiting the first come, first serve basis --- at least in part, left to chance, or even a policy that we are uncomfortable with the definition and implementation. Therefore we do not understand why 90 years in Illinois is not the father may be a need to offer, as the daughter of 14 years, Alaska is at the forefront (or perhaps we have responded to his father to get money and girls was 14 it is not). Due to the fact that most of us are uncomfortable with the idea of limiting health care for reasons such as age, or Thurs services, technological innovation continues to drive the cost of health care for me very well at some point in May and criticism The judge in medical innovation for the community access to goods and other services will be provided (if they are so foolish as the problem of believing that you can keep borrowing money is not repeated again).
So what is the value that we have come? It varies. Risk of dying from a heart attack decreases by 66% since 1950 due to technological innovation. cardiovascular disease in the ranks of a number of cause of death in the United States, this seems a high value on a scale that a benefit has the right part of the population in important ways. Since the development of pharmacology, we are now able to treat depression, anxiety and even psychosis, much better than we first imagined between 1980 (when Prozac was first published). Obviously, an increase in healthcare costs of critical importance, we want to give.
But how can we decide whether the novelty value? research shows that innovation (if proper care) was a significant clinical benefit (Aricept is a good example of a drug that works, but there is little clinical benefit in patients with dementia tests --- the sound of cognitive skills, the All but unlikely to be significantly more functional and better remember their children when they are not). However, comparative studies on the effectiveness of long duration to complete, and can not be fully implemented for each patient, this means that some health care providers is to always use common sense and problems of medical patients.
Who is best placed to assess the value to the community for the benefit of an innovation --- that is, to determine whether the benefits of innovation greater than the costs? I would say that the group paid at the end: the American public. How to reconcile public opinion and communicate effectively with policy makers effective enough to influence current policy, but also extends beyond the scope of this position (and maybe the imagination of a person).
The problem of access to a large proportion of the population is uninsured or underinsured, to reduce or eliminate their access to health care. Therefore, this group is the path of least (and resistance to the cheapest rooms) --- --- trouble is significantly weakened the ability of ER doctors in our country to the attention needs to reach in time. In addition, records indicate a looming shortage of primary care physicians compared with demand for their services. I believe that this imbalance between supply and demand explain the poor customer service to patients in comparison with our system every day waiting periods for medical appointments, long waiting times at doctors 39; office after his appointment the day , short-term doctors in exam rooms, followed by difficulties in reaching their physicians between visits, and ultimately delays in receiving test results. This imbalance is probably only partially mitigated by the use of lower health care by patients.
GUIDELINES solution, as the authors Steven Levitt and Stephen Dubner Freaknomics state, "If morality is what people want the world to work, the economy is how it really works" Capitalism is based on the principle of enlightened self-interest a system. This encourages conduct that would bring benefits to both suppliers and customers and the community as a whole. But when incentives go haywire, people start to do the best to go often to the detriment of others or even their spending on the road. Despite the changes that make our health system (and there are always more than one way to skin a cat), we must be sure to include incentives for behavior that results in any part of the system contribute on its stability in the country for a concern.
Here is a summary of what I think the best recommendations come along for the problems I described above: one to solve. Changing insurance companies way of thinking to do business. insurance companies have the same purpose as any other business: maximize profits. And if a health insurer is publicly traded in his 401k portfolio, you want to increase benefits, too. Unfortunately, the best way for them to do is to refuse its services to customers more for their pay. It's hard to risk (the function of an insurance company for distribution), compared to say, car insurance, because people are too moreinsurance stated that car insurance claims. Therefore, it seems, from the perspective of consumers, private health insurance model is wrong. We need a barrier to health insurance claims (or the opposite, an additional incentive for them to pay for denied making). Allow and encourage competition, Aaro State security is at least partly relevant to the market forces to drive down insurance premiums and new markets for local insurance companies for the benefit of insurance consumers and suppliers. their customers are now armed with the might of interest to see elsewhereInsurance companies can get the quality they actually provide services to their clients (for example, payment of claims), as a way to preserve and grow their businesses to watch. For it to work, monopolies or semi-monopolies to be abolished, or at least discouraged. Although this works, but the public probably still rules health insurance for some of the worst atrocities have taken place to stop growing (for example, insurers must notallowed customers to stratify into subgroups by age and by increasing the risk premiums old high average disease group for health reasons older consumers ultimately punished for their age rather than their behavior). Karl Denninger suggests some interesting ideas in a post on his blog to require insurers to offer similar rates to businesses and individuals, as well as creating an obligation to "open enrollment" periods during which participants may choose either any plan annually. This will avoid people to get insurance when they became ill, which prevents the problem of adverse selection leading insurers are paying existing conditions decline. I would add that, regardless of reimbursement rates for health, health care depends on the future (once the whole post in itself), all health insurance plans, whether private or public, health professionals should turn in part equal, the link, "good" and "security is wrong, which is currently responsible for motivating hospitals and physicians to restrict or deny service to the poor and may be responsible for the same thing for future progress of the elderly (Medicare to pay a little better than Medicaid). Finally, because the idea of an option "public" insurance plan is open to all, I am afraid that if it is more cheaper than private alternatives, while nearly a benefit across the country in droves to ride the occupied private insurance companies and forcing everyone to support each other with higher taxes and less health care decisions, but at the same time as the cost to consumers of "public choice" is comparable with the private alternative will be if not many people can not afford it.
2. Motivating people to healthy lifestyle, which indicated to prevent the disease continued. Prevention of disease is likely to save money, although some have said, adds to the life chances of developing diseases that would otherwise have occurred, and the overall health care system dollars (even if it's true year of life should be considered more valuable enough additional cost. In the end, so that all of improving the quality of health care and the number of life save the company money, let's not put the cart before that) .. But the idea of preventing a possible bad outcome in the future is just as bad psychologically motivate many people have so many problems, exercise, eat well, lose weight, stop smoking, etc. The idea of rewarding the desired behavior , financial and / or financial punish undesirable behavior is highly controversial. Even though I am afraid that this kind of risk strategy for the implementation of policies that undermined the fundamental freedoms or take, I'm not opposed to creative thinking about how our forces can use strong motivation to help people achieve health goals that they want to achieve. Ultimately, most overweight people lose weight. Most smokers want to quit smoking. They may be more effective than they could find more powerful motivation.
Over-third of health care falls by doctors. I understand Gawande way for doctors to stop overutilizing health care resources available is a laudable goal, which would be a considerable expense cage store will require a willingness to experiment and it will take time. And I agree that focus only on who should pay for our health (public or private) will not issue enough. But exactly how to encourage doctors, whose feathers are responsible for most of the money spent on health care rather than focus on what is really best for their patients? The idea that foreign agencies or government insurers --- --- panels can be used for medical care standards to determine the most ridiculous track costs to manage. These organizations have no training or major concern for patients social needs can be trusted to make such decisions. Why else would we have doctors, if not used their skills gradient methods to be applied in complex situations? By modus operandi of the incentives system is free to compete with their obligations to their patients to stay in position better decisions about what tests and treatments are available, giving attention to the patient, while careful not to ensure the protection of himself (by refusing to take the head CT can be a headache thrills paternalistic, refusing to give chemotherapy is not hot) to be. Maybe we should eliminate financial incentives for doctors to worry about anything, but the benefit of patients, which means that doctors' salaries must be cut off from the number of apartments have been conducted and the number of controls to rule, and instead determined by market forces. This model exists in the University health care and do not look poor quality care when doctors feel fairly rewarded to encourage. Doctors should have a good life in order to compensate for years of training and large amounts of accumulated debt, but there is more financial incentive to practice medicine should be given the right to life insurance.
4. Reduce excessive use of healthcare resources by patients. This, I think we need at least three things: * provide adequate resources for legal problems (so that patients go to the trouble to colds, for example, but instead their physician primary care). This will be the "sweet spot" touch on the number of primary care physicians better control of access to primary care, not a matter of health care as the old model HMO, and selection and treatment. It will also require a recalculation of the compensation levels for primary care services with specialized services to encourage medical students to go into primary care (to stop the disturbing trend, in the last ten years.)
* A massive effort in public health education to improve its capacity of solving their problems (increased so that patients do not really anywhere to go for a cold or ask for an MRI on his back when your doctor Tell them that faith is only one race).
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