Reforming payment or provision: What’s best for healthcare?
Posted by steven_spear | Under health care, process excellence Friday Jul 10, 2009The New York Times featured two distinctly different understandings of what ails health care. According to an editorial (”Financing Health Care Reform,” July 6, 2009) the problem is lack of financing, so the problem is shifting costs — do you or don’t you tax health care benefits and if you do, at what threshold? Do you or don’t you tax behaviors that contribute to ill health — not just smoking by consumption of sugared foods? Is lack of exercise next? Do you tax other things to subsidize health care? The obvious downfall of this approach is that it demands trade offs, more cost for more care, or more cost for you to get less cost for me. It doesn’t drive more, better care for both of us at less cost for each.
According to Paul O’Neill (”Health Care’s Infectious Losses,” July 5, 2009) the problem is in the delivery of care. An intolerable number of people get needlessly hurt–mis medication, patient falls, surgical site infections, ventilator pneumonia–driving quality down and driving up costs — in terms of human suffering and in terms of treating avoidable complications. The solution to this is transparency–where do delivery inefficiency and ineffective exist? — and better management — achieve ever better access and outcomes with ever less effort and investment.
Given the overwhelming evidence that O’Neill is right — that better management leads to better outcomes, more access, and less cost, why is it that so called reformers focus only on cost shifting as their remedy?
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O’Neill right? Of course right! This observation is strengthened by economist Robert J. Samuelson in his article, “Health care “reform” that isn’t,” in the August 3rd edition of Newsweek.