Article at the National Bureau of Economic Research by David Cutler notes: (Body of article is behind pay wall)
Cutler begins by noting that productivity growth has been much slower in health care than in most other sectors of the economy. In other industries, productivity growth has been driven primarily not by the development of new goods but by new ways of organizing production, distribution, and sales, changes that jointly have resulted in more output per dollar of inputs. In health care, by contrast, there has been very little organizational innovation.
His analysis of the process of medicine identifies three issues resulting in high cost and inefficiency. First, in many instances such as prostate cancer and coronary artery disease and cancer of the elderly we provide expensive aggressive interventions that yield little survival benefit. Second he notes the poor coordination of our system so that for example diabetics often do not get optimal care–in the summary he does not discuss the influence of cost on this lack of care. Third he comments on the high cost of providing care and suggests greater use of technology and such interventions as checklists to improve the outcomes. I’m unconvinced by this part of the analysis
Medicynical Note: Participants in our non-system game it to increase revenue and profits for providers–procedures over other care– suppliers, and insurers.
Quality, efficiency and value are not part of the equation.