Over the past years it is apparent that the United States is not
effectively spending money on healthcare. We rank 35th for life expectancy,
which falls on the lower side, yet the United States spends more money on
healthcare than any other country. This should not be the case if the United
States is effectively using it's resources and allocating supplies and money
where it is needed.
One of the biggest problems is that doctors
and surgeons may be over paid in the United States and there are far too many
extra tests run at each visit. It is a very controversial decision because
doctors and surgeons are highly trained and skilled workers who save people's
lives. However, if health care costs continue to increase and life expectancy
for the U.S. continues to rank at the bottom of the totem pole than more
problems are going to arise. As a Type 1 Diabetic, I am in a hospital or doctor’s
office more than the typical human being. I tend to see many unnecessary tests
performed, whether it be on me or other patients. Now sometimes their is a
patient who is very sick and the prognosis is unknown. These situations often
require multiple tests which can get very expensive. However, I once went into
the hospital because my insulin pump malfunctioned so my blood sugar became
very high and I was headed towards ketoacidosis. I had been at the hospital
maybe an hour, when the radiologist came into get me to take an x-ray. I did
not need this x-ray for any reason but the doctors insisted and said it was
part of the work up. This is a prime example of an extra test that costs both
the hospital and me money and could have been avoided. Again, high salaries,
high costs and excessive testing need to be improved so that we can work towards
attainable health care costs for all and improve life expectancy. The system is
looking at shifting towards value based care which could be another necessary
step in lowering costs and improving the quality of care. This will allow
extra costs to be avoided as well as improve the quality of care.
Kayli, you make good observations. Please let me respond to a few specific points you raised. These replies are intended simply to give you a broader context with which to evaluate the issues through different lenses.
ReplyDeleteKayli said: "One of the biggest problems is that doctors and surgeons may be over paid in the United States"
My input: By what standard should society measure and set the appropriate pay for physicians, given their level of responsibility and years of arduous training? Most physicians don't finish training and start to earn a real paycheck until almost 30 years of age. Even then, the vast majority are burdened by medical school loans which can approach $500,000 (not unheard of). And if we say physicians are overpaid, then we should also say hospital administrators are overpaid, as are health insurance company executives, airline pilots, nuclear power plant operators, movie stars, etc. Pay is considered fair when it's commensurate with the level of responsibility, amount of training, and social value. And a lot of physicians have a considerable amount of business overhead which must be covered from gross receipts (rent, office employee salaries, office supplies, medical school loan payments, etc) before they realize net take-home pay. There is a vast gulf between physician gross pay (from what they charge the patient) and take-home net pay.
Kayli said: " and there are far too many extra tests run at each visit."
My input: Bingo. Welcome to the world of defensive medicine, where physicians live in fear of frivolous lawsuits (one not based on fact, but where it's cheaper for the malpractice insurance company to settle a bogus nuisance lawsuit out of court versus proving the physician's innocence in court). My wife's OBGYN has to generate $100,000 in revenue each year just to pay his malpractice insurance premium, and he's never been sued. Tort reform would go a very long way in this country to drive down both the cost and amount of testing.
I myself pay $10,000 a year for malpractice insurance policy to cover the small amount of moonlighting anesthesia I do in the private sector. I have 25 years experience and have never been sued. Yet I have to generate $10,000 a year in revenue just to cover my own malpractice policy.
The only way to completely control physician pay (and other healthcare costs) is to socialize the entire healthcare system, making all healthcare providers outright or de-facto employees of the government. That is a different issue unto itself, and its discussion could take up an entire semester.
I applaud your recognition of these issues and giving them due consideration.
Hi Kayla,
ReplyDeleteThere are many issues that contribute to the high cost of health care in the US. As I imagine you have learned in class, reimbursement models and various incentives help drive this. If providers were to focus on quality rather than quantity, they may preform far fewer tests. I encourage you to look into Accountable Care Organizations as we have a few starting in Boston in March 2017. Both BCH and Brigham are separately entering ACOs contracts.
A very famous article that I recommend you read is called "It's the Prices, Stupid!" Not sure if you have come across this article in the HMP program but it has stood the test of time and made a big impact when it was first released. Here is the link to the PDF https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.22.3.89