A Weblog of Centrist Voices in American Politics
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A Weblog of Centrist Voices in American Politics | |
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July 23, 2005Medicare as a National Health Care Model? Not so fast!Bad Practices Net Hospitals More Money Medicare's handling of Palm Beach Gardens is an extreme example of a pervasive problem that costs the federal insurance program billions of dollars a year while rewarding doctors, hospitals and health plans for bad medicine. In Medicare's upside-down reimbursement system, hospitals and doctors who order unnecessary tests, provide poor care or even injure patients often receive higher payments than those who provide efficient, high-quality medicine.Posted by Tully at July 23, 2005 11:09 PM Comments
This story reminds me of an interview radio program I heard a few months ago. A doctor and, I think, a journalist had written a book on our health care system. One of the things they pointed out was that sometime in the early 80's, a for-profit business model was applied to health care through various government policies. This had a number of ill (no pun intended) effects on how care was provided and administered/accounted. In the for-profit model, the goal is to "sell" as much of your "product" as possible. This is the opposite of what should apply to medicine. Good medicine should be self minimizing. Good and effective care should keep the patient out of the doctor's office or hospital as much as possible in the future. Prevention is better than cure. Cure is better than treatment. One of the consequences of the business model's application was the use of "just in time" inventory in hospitals. This is where consumables are kept in as low supply as possible and replaced as needed, like bolts would be replaced in an automobile manufacturing facility to minimize the costs of storage. Of course, the "production" in a hospital is subject to more volitile outside influences than that of a manufacturing plant. "We'd like to perform your emergency open-heart surgery, but we're waiting for hospital gloves. Why don't you try the hospital down the road?" That's just one example of how such policies manifest themselves, but I think it's pretty illustrative. The whole thing strikes me as the tail wagging the dog. Let the accountants stick to accounting. You see the same kind of thing occur in various enterprises where someone who only looks at the numbers, but doesn't really understand the day-to-day business, has an undue influence on the model. You don't run the business (i.e. dog) in such a way that makes sense for accounting (i.e. tail). You account in such a way that makes sense for the business. Posted by: WHQ at July 24, 2005 09:33 AMHere's a key phrase from the article: as much as $1 of every $3 is wasted on unnecessary or inappropriate care.The fight occurs between the payor and the provider over "unnecessary or inappropriate". Docs do not like being told that their proposed treatment is "unnecessary or inappropriate". Telling them that is part of my job and they don't like hearing that from a doc let alone a Medicare official. Posted by: c3 at July 24, 2005 11:56 PM |
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