Everyone complains about health care costs, but no one does much about it. There is no accountability; The rising costs of treatment are passed on to the purchasers and the taxpayers by the health insurers, and government programs such as Medicare and Medicaid. Ironically, we know what is needs to be done to control cost, but there is no leadership. Here are a few exercises in the obvious on health care costs:
1. A large fraction of the health care dollar is spent treating conditions that result from lifestyle choices. We have strong data on the effectiveness of social policy interventions in reducing tobacco use, obesity, substance, alcoholism, and the spread of HIV. Taxation of tobacco products and sugar-containing soft drinks are effective strategies, but under-utilized. Regions with lower tobacco taxes have higher rates of tobacco related disease. Information posted on other portions of this website allow local communities to take charge of some of their costs.
2. The incentives in health care delivery still strongly favor treatment and over treatment. Sicker patients require many more services, but all too often these services are provided in hospitals rather that people's homes. There has been substantial progress in implementing value based care through Pioneer ACOs but these types of projects are still debated because of concerns regarding the detailed financial projections. As a result, progress is stalled. The structure of healthcare financing provides strong disincentives for investing in health. The benefits of smoking cessation or weight loss can only be measured years in the future, yet health insurance is based on an annual model. Insurers are reluctant to invest in people’s health today in the hope of future savings.
3. The current payment system for health insurance claims facilitates fraud waste and abuse. The same mechanisms that allow doctors to be paid promptly, are used by entrepreneurs to bill for services never rendered. Health Insurers and the government have to pay and chase. While the papers are filled with news of arrests and recoveries, the majority of fraud waste and abuse remains unabated.
4. An important corollary of value based care is the reduction in use of low value services. An ongoing educational effort by the ABIM called "Choosing Wisely" is a compendium of procedures that create little or no value for patients. https://www.choosingwisely.org/