Elliot Fisher, a professor at
National Public Radio had a story yesterday morning entitled “A Painless Way To Cut Health Care Costs?” Fisher was quoted extensively – pointing out that we should move away from fee for service payment methodologies we could eliminate a lot of medical costs. (I agree). Reporter Julie Rovner wondered if this means that slowing the growth of health care costs “doesn’t have to hurt.”
It all depends who you are.
If you are a patient, decreasing variation is good. Decreasing variation means that we offer more reliable health care, and decreasing overutilization will prevent medical errors and lower patient copayment and coinsurance charges. No problem there.
If you are an employer or the government purchasing health insurance – ditto. Decreasing variation (and increasing the prevalence of evidence based care) should lead to higher value in the health care purchase. Sign me up.
But is this likely to be painless for hospitals and doctors? Not by a long shot!
Health care, at 1/6 of the economy, employs a lot of people and creates an enormous amount of wealth. In most communities with a hospital, that hospital is the major employer in town. The top ten nongovernmental employers in
In a sense, if we cut out 30-35% of all hospital revenues, we would end up with Detroits all across the country (especially in
Let’s also not forget that the
I agree with Fisher and others that we should work hard to decrease variation and by so doing decrease utilization. In many instances (like preventive care), decreasing variation and increasing evidence based care will actually increase utilization and costs; I favor this too.
But I would not call solving this problem “painless, “ and I would not underestimate how difficult it will be to overcome opposition to efforts that would undermine the current business model.