Donations Aren't the Real Solution
It was encouraging to see the pharmaceutical industry's $80 billion voluntary reduction of prescription drug expenses over ten years. We know that health reform needs an upfront investment and it was good to see big pharma chipping in.
That said, I have two concerns. First, this is a voluntary agreement made behind closed doors with few details available to the public. Voluntary commitments are easily forgotten or overturned. It's also not clear what was promised in exchange for the concession from pharma.
My second concern is that we will start to look for more such voluntary concessions as a path to paying for reform. If we really want to reduce costs now and in the long term, we will not succeed by asking stakeholders to donate their profits. We will need to structure our health-care system to allocate value properly.
Where we put our money is the most clear indication of what we value. If we pay for procedures, tests, and patient visits (as we do in our current system), then we will get more procedures, test, and patient visits. This does not always mean better, higher-quality health care -- it just means more health care. The only thing more health care guarantees is higher cost. Furthermore, as any patient or physician can attest, more health care comes with its own risk of complications. For example, spending more time in a hospital puts people at higher risk of developing clots. Having unnecessary CT scans can expose patients to the risk of radiation and the potentially toxic effects of contrast agents.
What we really need to do is pay for what we value: good outcomes and patient satisfaction. If we do this, there's reason to believe we will generate better outcomes and satisfaction.
Figuring out how to design and implement a system that reward quality over quantity is a monumental challenge. It will require restructuring primary care, implementing payment reform, enhancing prevention and wellness programs and integrating non-physician care providers more effectively just to name a few essential components. But the rewards will be tremendous -- higher-quality health care at lower cost. Lower cost results in part from earlier detection and treatment, greater efficiency in the delivery system, and decreased utilization of services that don't improve the quality of care.
Before we can do any of this, we must summon the political will to pass a comprehensive health reform bill. Many stakeholders are wary of reform and of what they may lose in a restructured health-care system. But the most important stakeholders of all -- patients -- are struggling under the yoke of high costs, poor access and undependable quality. We owe it to them to begin this reform process with a strong health reform bill in 2009.
Posted by: preventionmd | June 26, 2009 11:31 PM
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