Medicynic

This is from Economix–quoting Dr. David Cutler:

Medicynical Note: For every doctor there are 5, countem, five administrative and office support staff–and that doesn’t count another 500,000 “management” types. Guess who pays?

This from the New England Journal of Medicine in an article by Molly Cooke:

It is old news that the cost of medical care in the United States is unsupportable, yet we seem unable to grapple with the issue effectively. As current ideas for health care reform have percolated through Congress, cost-control mechanisms have generally been recognized as the weak component. Our country is remarkably generative in the development of new diagnostic tests, drugs, and procedures — and remarkably undisciplined in their deployment. New diagnostic and therapeutic procedures and the broadened application of established ones account for two thirds of the growth in health care expenditures.

Cooke believes medical schools and teaching institutions have a responsibility to teach cost consciousness in health care. Such a responsibility would seem natural given that health care is the largest expense of many people’s lifetime.

But:

Philosophically, we physicians have conceived of ourselves as, and taught students that we are, advocates for each patient, obligated to eschew all considerations other than benefit to that patient and his or her preferences.

And:

A predominant driver of the cost of hospital care is the length of stay, so a high priority is readying patients for discharge — which serves as a rationale for preemptively ordering any test and consultation that might be called for, to avoid delaying discharge. Consequently, students and residents have scarce opportunity to practice devising cost-effective diagnostic strategies and explaining their rationale to patients and families.

And

Finally, cultural values powerfully influence the selection of teaching topics. Academia celebrates the “high knowledge” of medicine: pathophysiology, molecular biology, genomics. Even evidence-based medicine, although it deemphasizes fundamental mechanisms, is regarded as acceptably intellectual in comparison with “low,” real-world concerns such as cost.

Medicynical Note: Teaching cost consciousness would apprear to be a no brainer given the near 17% of GDP spent on health care, the excessive costs of health care in the U.S. compared with elsewhere, the high medical related bankrupcy rate in our country, and our yearly excessive increase in health care costs. The article goes on to point out the urgent need to change and to value value!

Pricing of health care in Massachusetts was analyzed by the Attorney General of that state. She found:

A. Prices paid by health insurers to hospitals and physician groups vary significantly within the same geographic area and amongst providers offering similar levels of service.

B. Price variations are not correlated to (1) quality of care, (2) the sickness of the population served or complexity of the services provided, (3) the extent to which a provider cares for a large portion of patients on Medicare or Medicaid, or (4) whether a provider is an academic teaching or research facility. Moreover, (5) price variations are not adequately explained by differences in hospital costs of delivering similar services at similar facilities.

C. Price variations are correlated to market leverage as measured by the relative market position of the hospital or provider group compared with other hospitals or provider groups within a geographic region or within a group of academic medical centers.

D. Variation in total medical expenses on a per member per month basis is not correlated to the methodology used to pay for health care, with total medical expenses sometimes higher for risk-sharing providers than for providers paid on a fee-for-service basis.

E. Price increases, not increases in utilization, caused most of the increases in health care costs during the past few years in Massachusetts.

F. Higher priced hospitals are gaining market share at the expense of lower priced hospitals, which are losing volume.

G. The commercial health care marketplace has been distorted by contracting practices that reinforce and perpetuate disparities in pricing.

Medicynical Note: Why do we pay more? Because our health care system is not a system. It’s a mechanism for manipulation and wealth accumulation not health care.

Health Insurance giant Anthem Blue Cross said it was raising rates on thousands of individual policyholders in California because the cost of their medical care exceeded the premiums they paid last year.

At the same time, other parts of Anthem reaped a profit. A Times analysis of the company’s regulatory filings shows that $525 million in Anthem’s earnings in 2009 was shipped to its corporate parent WellPoint Inc. The analysis was not disputed by Anthem.

Anthem Blue Cross has been so profitable that, since WellPoint acquired it in 2004, it has contributed more than $4.5 billion to the parent company’s bottom line.

Medicynical note: These hikes reveal the insurer’s strategy of segregating patients into risk groups. It allows Anthem to selectively raise rates on those who cost them more. So if you have a small group with a few patients with illnesses your rates will go up. If you are an individual buying health insurance you rates go up if you have illness, frequently to the point that you can’t afford the coverage. The rate hikes are designed to do just that.

Quite a system. Insurer’s can systematically extinguish their risk. Patients who need the coverage most are priced out of the market. They are forced to bankruptcy, government programs, and “free” ER use–the republican health plan.