In the meantime, I've posted the final slides from the Fall course, Managing Health Care Costs, at Harvard School of Public Health. Here are my eighteen observations - the slides contain substantially more detail.
Observation One: Sick people are expensive to care for!
Observation Two: The problem in the US is cost per unit, NOT utilization
Observation Three: We are too sedentary, too fat, and smoke less than we used to, but still too much.
Observation Four: We don’t like to make tradeoffs!
Observation Five: There is HUGE Variation
Observation Six: Fee for service is toxic (but everything else is difficult)
Observation Seven : There is a cultural clash between those seeking to preserve the “art” of medicine, and those looking to create more reliability and cost effectiveness through industrial redesign
Observation Eight: We pay a heavy economic and noneconomic price in our effort to banish uncertainty
Observation Nine: We often promote competition that does not generate new value for patients, and reject competition that could create such new value.
Observation Ten: We “medicalize” many conditions, driving up cost
Observation Eleven: Many see a primary care shortage
Observation Twelve: We are reluctant to regulate prices (and when we do, we often do it poorly by design)
Observation Thirteen: Providers must consolidate to allow for more integrated payment; however, provider consolidation increases the cost per unit
Observation Fourteen: We often mistakenly think that we can measure the cost of health care by medical claims alone
Observation Fifteen: You can’t ‘reform’ an industry representing 17% of the GDP without angering many, and without unintended consequences
Observation Sixteen: Americans will pay for a larger portion of their health care out of pocket over the coming years, and this is likely to lower utilization
Observation Seventeen: Physicians are more likely to prescribe treatment associated with high margins for their practices
Observation Eighteen: There are no magic bullets
1/14/12 Addendum: Here's the OECD list of out of pocket payments. Remember that the total cost of health care is so much higher in the US than elsewhere that a lower percent of health care spending still means a higher portion of personal income. Thanks to Vegncook for comments.
1/14/12 Addendum: Here's the OECD list of out of pocket payments. Remember that the total cost of health care is so much higher in the US than elsewhere that a lower percent of health care spending still means a higher portion of personal income. Thanks to Vegncook for comments.
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