Wanna cut some med costs 30+% without sacrificing quality? Just have patients rely more on CVS, Walmart, etc. for care. From the Post: Walk-in medical clinics run by CVS, Wal-Mart and other retailers provide care for routine illnesses that is as good as, and costs less than, similar care offered in doctors’ offices, hospital emergency rooms and urgent care centers, according to a new Rand Corp. study. … Physicians groups … have raised concerns about the quality of care in the retail clinics, particularly about whether they over-prescribe medications since many of them are owned by pharmacy chains and whether they do adequate follow-up. But the Rand study found no major differences in these areas between the clinics and the other medical sites surveyed. …
> the next logical step is to allow physicians to have pharmacies
Am I missing snarkasm? I used to work for a multi-doctor practice. We had our own pharmacy; one of my assignments was to figure out if it was profitable.
A quick glance suggests to me that the study only measures cost, not where the money goes. The three possibilities that jump to my mind are profit, waste, and subsidies to other forms of healthcare. The first one is the most likely to my mind, mainly cost in the form of rent to the artificially limited resource of doctors. Assuming the artificial limitation is fixed, deploying them here is a form of waste.
But I want to stick in a word about the third. My pet peeve about American healthcare is that it is not transparent. A lot of medical billing is inflated in the hope that it will pay for unprofitable sectors, particularly ER. This is a form of price discrimination, one of the largest examples I know. In theory, monopolistic price discrimination and competition both produce efficient outcomes. But I'd feel a lot safer with government interventions (subsidies, for example) in a price system than a monolithic system designed for non-transparency.
And last but not least --- I can hardly imagine, UTIs, sore throats, and ear aches -- costing more than 1% of the health care budget. (removing ER visits, which are usu. inappropriate for this kind of stuff)
I don't have time to look at the details of the study --- but absolutely none of these conditions should be treated in an emergency room -- that is not a cost effective place to treat this kind of stuff. People who go to the ER for this, if I had to guess, either have failed conventional therapy -- and were told by their primary provider to go the ER if sxs didn't get better in X days -- or are lower SES and have lots of comorbidities or significantly bad health habits. (Both of which I would guess are absolutely poorly controlled, by whatever observational method RAND used).
Second -- if you break down the barrier between pharmacies and care providers -- the next logical step is to allow physicians to have pharmacies -- I think you can imagine the cost implications of that.
Third, conditions like UTIs -- especially recurrent ones, in women who already have a regular physician -- probably don't even need a visit with anyone. The issue is that a brief phone call encounter is not re-reimbursable at all. (Generally people with multiply recurrent UTIs are given prescriptions for antibiotics, that they start on their own accord when sxs. start).
Well, Obama claims (and I believe him) to want to reduce emergency-room usage for "routine illnesses". Seems reasonably likely that once the uncovered people who end up going to ER's for these illnesses are covered by some form of insurance, some fraction of them will end up going to these types of in-store clinics. I haven't read the study, so I can't evaluate the issues some people have raised about whether people go these clinics with more serious illnesses, and end up with worse outcomes. I really don't think Obama would object if the reforms ended up giving more business to CVS, Walmart, etc...and the care they got was demonstrably as good as they'd have gotten elsewhere... that's not to say he'd advocate writing particular businesses into a plan by name...
However, I have a friend who works for NICE in healthcare policy who I trust and who claims that the NHS is twice as cost effective as the current, competitive US system; he claims that there are systematic reasons why healthcare doesn’t behave as one would expect it to: namely that competition worsens the performance of the system.
I guess that's "systematic" and a "reason," but I'd like evidence for it.
Does he know about the system in Singapore? It is a counterexample to the vast majority of sweeping claims that people make about healthcare, including the obvious interpretation of this statement. Singaporean healthcare is competitive, by most meanings of the word. I don't know any demographically-adjusted numbers for it, but unadjusted, it appears much more cost-effective. Probably adjustment would make it merely comparable.
Why wouldn't Obama want care that's easily delivered to the poor and elderly in cities and even in rural areas? Remember that our allocation of doctors and medical facilities is clumpy, with many in some locales and almost none in others. A CVS in a city may be by far the best way to reach a patient population. The test then would become how to push matters further into the medical system as needed - and that should become easier with general coverage because then clinics could actually direct people to doctors who otherwise can't go anywhere but an ER.
If one takes the view that medicine is almost entirely useless, as Robin does, then you should be able to cut costs by at least 90% by employing fake doctors with no training in medicine to give out placebo pills.
A milder Hansonian analysis would indicate that most of the benefit of medical interventions comes from the simpler, most well-established procedures, which are also the cheapest, so this would indicate that wall-mart and co. will probably be much more cost effective than a noncompetitive alternative such as the UK NHS.
However, I have a friend who works for NICE in healthcare policy who I trust and who claims that the NHS is twice as cost effective as the current, competitive US system; he claims that there are systematic reasons why healthcare doesn't behave as one would expect it to: namely that competition worsens the performance of the system.
Conspicuously absent from those statistics is any mention of how well retail clinics handle non-routine illnesses, and how often they misdiagnose serious illnesses as routine ones.
"Think he’ll be eager to publicly adjust his med reform to give Walmart more business?"Heh. No. But I'd change that answer to a "yes" in a minute, if Walmart appeared willing to kick back enough money to Obama's "friends". It's the Chicago way, after all.
> the next logical step is to allow physicians to have pharmacies
Am I missing snarkasm? I used to work for a multi-doctor practice. We had our own pharmacy; one of my assignments was to figure out if it was profitable.
re: diogenes
A quick glance suggests to me that the study only measures cost, not where the money goes. The three possibilities that jump to my mind are profit, waste, and subsidies to other forms of healthcare. The first one is the most likely to my mind, mainly cost in the form of rent to the artificially limited resource of doctors. Assuming the artificial limitation is fixed, deploying them here is a form of waste.
But I want to stick in a word about the third. My pet peeve about American healthcare is that it is not transparent. A lot of medical billing is inflated in the hope that it will pay for unprofitable sectors, particularly ER. This is a form of price discrimination, one of the largest examples I know. In theory, monopolistic price discrimination and competition both produce efficient outcomes. But I'd feel a lot safer with government interventions (subsidies, for example) in a price system than a monolithic system designed for non-transparency.
And last but not least --- I can hardly imagine, UTIs, sore throats, and ear aches -- costing more than 1% of the health care budget. (removing ER visits, which are usu. inappropriate for this kind of stuff)
I don't have time to look at the details of the study --- but absolutely none of these conditions should be treated in an emergency room -- that is not a cost effective place to treat this kind of stuff. People who go to the ER for this, if I had to guess, either have failed conventional therapy -- and were told by their primary provider to go the ER if sxs didn't get better in X days -- or are lower SES and have lots of comorbidities or significantly bad health habits. (Both of which I would guess are absolutely poorly controlled, by whatever observational method RAND used).
Second -- if you break down the barrier between pharmacies and care providers -- the next logical step is to allow physicians to have pharmacies -- I think you can imagine the cost implications of that.
Third, conditions like UTIs -- especially recurrent ones, in women who already have a regular physician -- probably don't even need a visit with anyone. The issue is that a brief phone call encounter is not re-reimbursable at all. (Generally people with multiply recurrent UTIs are given prescriptions for antibiotics, that they start on their own accord when sxs. start).
Well, Obama claims (and I believe him) to want to reduce emergency-room usage for "routine illnesses". Seems reasonably likely that once the uncovered people who end up going to ER's for these illnesses are covered by some form of insurance, some fraction of them will end up going to these types of in-store clinics. I haven't read the study, so I can't evaluate the issues some people have raised about whether people go these clinics with more serious illnesses, and end up with worse outcomes. I really don't think Obama would object if the reforms ended up giving more business to CVS, Walmart, etc...and the care they got was demonstrably as good as they'd have gotten elsewhere... that's not to say he'd advocate writing particular businesses into a plan by name...
@Douglas Knight:
I have not heard about the Singapore system.
However, I have a friend who works for NICE in healthcare policy who I trust and who claims that the NHS is twice as cost effective as the current, competitive US system; he claims that there are systematic reasons why healthcare doesn’t behave as one would expect it to: namely that competition worsens the performance of the system.
I guess that's "systematic" and a "reason," but I'd like evidence for it.
Does he know about the system in Singapore? It is a counterexample to the vast majority of sweeping claims that people make about healthcare, including the obvious interpretation of this statement. Singaporean healthcare is competitive, by most meanings of the word. I don't know any demographically-adjusted numbers for it, but unadjusted, it appears much more cost-effective. Probably adjustment would make it merely comparable.
Why wouldn't Obama want care that's easily delivered to the poor and elderly in cities and even in rural areas? Remember that our allocation of doctors and medical facilities is clumpy, with many in some locales and almost none in others. A CVS in a city may be by far the best way to reach a patient population. The test then would become how to push matters further into the medical system as needed - and that should become easier with general coverage because then clinics could actually direct people to doctors who otherwise can't go anywhere but an ER.
Where can I read the true view?
You again misread my view.
If one takes the view that medicine is almost entirely useless, as Robin does, then you should be able to cut costs by at least 90% by employing fake doctors with no training in medicine to give out placebo pills.
A milder Hansonian analysis would indicate that most of the benefit of medical interventions comes from the simpler, most well-established procedures, which are also the cheapest, so this would indicate that wall-mart and co. will probably be much more cost effective than a noncompetitive alternative such as the UK NHS.
However, I have a friend who works for NICE in healthcare policy who I trust and who claims that the NHS is twice as cost effective as the current, competitive US system; he claims that there are systematic reasons why healthcare doesn't behave as one would expect it to: namely that competition worsens the performance of the system.
Conspicuously absent from those statistics is any mention of how well retail clinics handle non-routine illnesses, and how often they misdiagnose serious illnesses as routine ones.
"Think he’ll be eager to publicly adjust his med reform to give Walmart more business?"Heh. No. But I'd change that answer to a "yes" in a minute, if Walmart appeared willing to kick back enough money to Obama's "friends". It's the Chicago way, after all.