Chasing the Rabbit: Official Blog by Author Steven Spear

Talk of universal coverage and health care reform largely focuses on who pays—employers, employees, or taxpayers–and how much gets spent.  That avoids the issue of how we achieve better care for more people with less effort and less cost–doing much more with much less, putting to far better use the resources we commit to this sector. 

The single biggest impediment is the lack of effective _outcome_ based measurement.  Though there is HUGE variation in efficacy and efficiency of treatments and providers (see previous post in response to Paul Krugman op ed), it is incredibly difficult for payers and patients to see those differences and make wise choices accordingly.  This rewards those least capable and punishes those who are most capable.

Any healthcare reform package should break the fee for service model, which leads to worse care, denies access, and drives up costs.  It makes as much sense as paying for other products and services regardless of the time idle by people and machines or the material that is wastefully scraped.  Furthermore, it penalizes those organizations that have learned to deliver better care, to more patients with less effort and cost and actually rewards those who are less capable, competent, and motivated to get better.

Instead, push for outcome measures so payers and patients can distinguish among providers based on value created.  CMS has started this with the simple measures of whether “never events” like central line infections occur or not with a refusal to pay additional costs to providers that allow these avoidable complications to occur.  There is no reason more sophisticated measures cannot be created.  Once in place and used by CMS, the VA, and others, the private sector too will follow suit, directing traffic to those organizations most prepared to put scarce resources to good use and away from those that squander them.  The result?  A healthier populace with wealth freed to tackle other priorities.

Related posts:

1. Criteria for Judging Healthcare Reform…
2. Measuring Therapeutic Effectiveness and Cost–One Part of Better Care for All
3. Healthcare Reform Linchpin: Measure Value Added and Reimburse Accordingly…
4. Brooks Right, Krugman Wrong on Healthcare ‘Reform’ Legislation
5. Measuring Value-Added, not Compliance, Key to Health Care Reform