Saturday, November 14, 2009

Insurance, cost control, medical information technology

health insurance

Thoughts on health insurance: Various insurance policies can insure you against different levels of health care needs from catastrophic-only needs to comprehensive health care needs. Policies are so complex that few people buying them feel comfortable comparing one policy against another. Few people I talk to have the knowledge to understand the many types of serious and even rare medical conditions they or their family members might get or the potential costs they could encounter if they got such a diagnosis. Making clear standards for health care insurance coverage would help people compare policies and choose what risks they can bear in exchange for lower cost policies.

The fact that medical costs are the cause of over 50 percent of U.S. bankruptcies indicates that many people had no idea of the potential costs of serious medical conditions and were either uninsured or underinsured. This argument comes up in discussing allowing insurers to sell insurance across state lines. Many states have specific health care coverage standards to ensure people get coverage for the most serious and costly unexpected needs while other states do not.

Where health care dollars go: Health insurance is based on 5-6 people paying into a fund so that 1 person who needs a lot of care can pay for it and the others can be glad their health care costs are minimal. Given that people cannot readily predict who will get serious medical illnesses or conditions, when you buy a policy, you hope you won't really need high-cost services but you buy it to cover the possibility you may be the one to need it. The statistics show that 85 percent of health care costs are needed by a very small 15-20 percent of the population who get very serious acute or chronic medical conditions like cancer, severe heart disease, diabetes, stroke, severe accidental trauma, and rare diseases like multiple sclerosis, kidney failure needing dialysis or kidney transplant, etc. The rest of the people use the remaining 15 percent of health care dollars for preventive and intermittent acute medical care. As the possible treatments for diseases have grown, high-cost pharmaceutical therapies, more detailed and expensive diagnostic tests, complex surgical interventions, high-tech radiation treatments, and growing sub-specialty care have all grown in a system that rewards doing more without having to show that more is better. In addition, despite being the country at the heart of high-tech innovation, we are just now investing in the health IT that will better allow us to fully report and analyze how our various medical interventions impact people's survival, quality of life and length of life.

Does controlling or lowering costs mean rationing? To ensure our businesses remain competitive in a global economy, we need to keep people healthy and do it cost effectively. The continuing rise in every aspect of health care above the economy's growth is unsustainable. Studies, such as the Dartmouth Atlas Study, and studies from other countries with universal access to health care show that Americans pay 2-3 times as much for medical care without improvements in our health. That is sobering as most of us would not pay unnecessarily for any product that did not provide a benefit to us. Without detailed access and reporting on health outcomes, patients and health care providers have not had immediate access to the best information to make decisions with. We have studies to show what works and what does not work for many common and serious diseases, but getting this accurate information to patients and their providers has been challenging before the Internet age. We have many studies showing that many people don't get standard therapies that are known to provide the best outcomes and many others get unnecessary and risky tests, treatments and procedures that don't improve their health. Experts and some model medical clinics have shown that we can expect to save at least 30 percent of our health care costs if we gave better care to people, especially those with chronic medical conditions like diabetes, heart disease, high blood pressure, obesity, mental illnesses and prevention for obesity, diabetes, many infections and certain cancers.

When we talk about spending our dollars wisely, this does not require rationing or threatened death panels, but instead requires a common sense approach to ensuring that people get the best proven, coordinated medical care in a timely manner to minimize suffering and disease. We also need to address dollars spent which do not improve our health such as excessive executive salaries, unnecessary health care overhead for paperwork and arguing between insurers and providers, as well as unnecessary testing and legal costs for defensive medicine. Competition is the American way to bring transparency and cost reductions to our market place. Increasing competition with products we can all clearly evaluate can ensure we get the best value for our health care dollar.

Personal medical health information technology could help us lower costs and improve care: With the expansion of health care IT with electronic health records at hospitals, doctor offices, clinics and even Web-based health records available through Google Health and Microsoft Health which will be controlled by individual patients, many more opportunities for each of us to get reliable advice on health improvements are possible, direct to our inboxes! People can monitor their medical, dental, eye and other health care, decide who of their doctors or hospitals or family members have access to which of their health information. The doctors and health care providers can study and advise people by phone, e-mail, send specific information and recommendations tailored to each patient with a goal of improving their total health and not just focusing on one problem in isolation.