Posts Tagged health care cost

Annual Exam — not needed and may be harmful

wellnessexamDON’T GET AN ANNUAL EXAM.  The data are clear — see the recent article in the New England Journal of Medicine and the op-ed in the New York Times — perhaps you missed this counter-intuitive health advice?

aircraftmaintenanceMechanical devices need preventative maintenance.  The aircraft mechanic in the illustration prevents engine failure by checking and replacing parts before they go bad.  He knows the MTBF (mean time between failures) for the various engine components.  You would think this is how the human body works but THAT’S NOT TRUE.  You don’t take out an appendix like a spark plug just because they sometimes go bad — you fix it only when needed because surgery hurts and has complications.

One third of the US adult population get annual physical exams and primary care doctors spend 10% of office visits doing those exams.  Sound research shows the annual physical is not needed and worse yet, may be harmful because of false positives (tests that say something is wrong but later are proven wrong).  It’s the very essence of a false positive — an abnormal test in a healthy person!  You know where that leads:  “we need to do some additional tests or a biopsy” — just hope it’s not a brain biopsy.

The US healthcare system needs the wasted 10% of primary care time elsewhere.   It’s totally crazy — doctors doing unnecessary annual exams that clog up the appointment calendar and make it hard for people with actual  problems to get an appointment.  And, a large number of people have health problems who don’t see health care providers when they should (but that’s another story)!

Doctors like to do annual physicals — it’s nice to visit with patients and not have to make any hard decisions.  And, they make a lot of money doing the exams under the guise of “maintaining a relationship”.  But, the exams are not needed.

A proactive patient would make health care appointments as needed for the following:

  1. Annual flu shot
  2. Tetanus vaccination every 10 years.
  3. Cholesterol test every 5 years
  4. For women over 40 a pap smear every 3 years and a mammogram every 2 years.

Do you really need to have a health care provider tell you the following things, or is this list enough?

  1. DO keep weight in normal range (BMI below 25)
  2. DO walk 30 minutes every day
  3. DO wear seat belts
  4. Don’t use drugs or alcohol
  5. Don’t smoke
  6. DO Check blood pressure every year (automated checks are just fine)
  7. DO see a health care provider if you have a health problem.

Keep in mind this discussion is about an exam for nothing in particular — just a “check-up” — which you don’t need.  On the other hand, a patient needs visits with a health care provider to treat and monitor abnormal conditions.  You need routine visits to adjust blood pressure medications, to treat diabetes, to treat acne and to evaluate arthritis.






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International Comparison — sky high cost


The Washington Post has a couple of great articles about the cost of health care in which the US is compared to other countries.

The table below is from the first article listed above.

Click on the graph for an interactive version. (SOURCE: International Federation of Health Plans. GRAPHIC: Wilson Andrews - The Washington Post. Published March 2, 2012.)

Both articles are written by Ezra Klein.  The data itself comes from the International Federation of Health Plans.   Mr. Klein points out the US as a country does not have the financial controls common in other advanced countries.  He concludes the rate of growth in prices as well as the current prices of health care simply must be reduced.  Other countries should serve as a model.

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The Culture of Quality – Priceless

There is no question that health care costs money.   But like anything we purchase we would like to get a quality product.  All the States in America pay for health care and to some extent are responsible for the quality of care in each State.  Control over quality is exerted through licensing and through medical and pharmacy boards.  Management of the Medicaid program is very directly the responsibility of the State.  How well do the States provide quality health care?  The chart below shows quality and cost rankings of the States.  The casual observer would conclude: the more money spent on health care the worse the quality.  Does money corrupt health care or is there some other answer?

Quality and Cost Rankings of States

The New England Journal of Medicine reports a reduction in death rate in States where Medicaid has been expanded.  This seems contrary to the previous data.  The more money spent by expanding Medicaid improves quality.   So does money corrupt or cure quality?

The answer to the previous question is simple:  it depends on management.  An effort to follow evidence based quality guidelines is usually rewarded with lower cost (see the example of asthma).   It does no good to stay within budget but fail to deliver quality (money “down the drain”).  The expanded Medicaid programs were showing better management and higher quality than some other State medical programs.

Sometimes, even with the best of intentions, health care money is wasted and poor quality results.  Dr. Donald Berwick, previously the head of the US Department of Health and Human Services, commented on the 5 main causes of waste in health care:

  1.  overtreatment of patients
  2. the failure to coordinate care
  3. the administrative complexity of the health care system
  4. burdensome rules
  5. fraud

Connecting the dots:

If a State contracts for a highway project there are engineering based  specifications on the final product.  Failure to have specifications for a highway leads to a bumpy road.   Failure to adequately specify evidence based health care  leads to waste, high cost and low quality.

The culture of health care in some states is collaborative and quality driven, and in other states the culture  is competitive and profit driven.  The Midwest tends to be the former (see the chart at the top).  The outcome for patients is better in a collaborative and quality driven environment.  Not just anybody can lead a health care organization.  The ability to build a culture of quality is essential for a government administrator or  a health care CEO.

The cost of US health care is about $8000 per person per year.   Other advanced countries achieve higher quality at a cost less than $5000 per person per year.   Excessive health care waste (Chalice, Robert. Improving healthcare using Toyota lean production methods : 46 steps for improvement — 2nd ed. Page 21) accounts for at least 30% of the cost of US healthcare.  The US must attack the problem of waste to reduce overall cost and at the same time foster a national culture of health care quality so all the States have similar high quality levels.

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