Universal coverage is a worthy goal, but if we get there by enrolling everyone in existing public and private insurance schemes and maintaining existing levels of utilization we’ll be doomed. Costs will go through the roof and providers will be overwhelmed.
The real secret to controlling health care costs is decreasing utilization of expensive interventions when lower cost alternatives that are equally or more beneficial are available. Here’s an example from MedPage Today (Exercise Is Neglected Therapy for Chronic Low Back and Neck Pain):
Less than half of patients with chronic low back or neck pain are prescribed exercise, one of the few moderately effective interventions, researchers… said.
In a survey of nearly 700 patients with chronic low back or neck pain, only 14.4% were prescribed exercise by their physicians, Janet Freburger, Ph.D., of the University of North Carolina at Chapel Hill, and colleagues reported in the February issue of Arthritis Care & Research.
Physical therapists and chiropractors were more likely to prescribe exercise, and to be fair to physicians, doctors often make referrals to PTs who then prescribe exercise.
There are other examples. I remember around 1995 a Glaxo Wellcome executive complaining to me that some managed care companies were insisting that members diagnosed with acid reflux first try sleeping on a wedge pillow before being granted payment for Zantac. Actually it seems like a good way to control costs while avoiding the possibility of medication side effects.
I hope that the comparative effectiveness institute that Obama wants will evaluate low tech, low cost treatments, not just expensive ones. I also hope that patients start to wise up and seek out the sort of managed care cost control techniques they rebelled at back when the employer picked up the whole premium and co-pays were $5!February 2, 2009