A Good Idea from Hillary…
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“Patients, providers and payers would benefit from getting better information on what works in health care and how treatments compare to one another. Little is known about how these procedures stack up, so we end up paying for them all, even when they may do nothing to improve health. Researchers at Dartmouth have found that more care is not better care, and that inefficient care may do more harm than good. Health care providers and patients are being bombarded with information. In the past decade, there has been an 80 percent growth in the number of drugs prescribed, 100 percent growth in new device patents, 300 percent growth in teaching hospital procedures, and 1,500 percent growth in diseases with gene tests.”
This is a direct quote from Hillary Clinton’s Presidential Campaign web site — calling for the creation of an independent “Best Practices” Institute for health care. And while we’re in the attic, I would point out that at a recent forum of health care academics and industry experts that was sponsored by the Government Accounting Office, 88% of those surveyed agreed that, “The United States should balance its health care research investments between new discovery and assessing comparative cost effectiveness for new and existing medical interventions.” 65% of those in attendance “strongly agreed” with that statement.
We will never solve the cost or quality crisis in health care unless the federal government decides to fund so-called “applications research” with the gusto and enthusiasm its brings to funding “basic research.”
For over ten years, I’ve told anyone who wanted to know that if I could do “one thing” in the health care space, it would be to create some kind of federal institute that would focus on health care delivery with the same energy and funding that we focus on advancing basic science. There are hundreds of opportunities — maybe thousands — to improve the practice of medicine by studying what works and why, and making that information available to practitioners, public officials, payors and consumers. It would also change the whole dynamic that exists today in medical education — which is primarily — almost entirely — focused on the advancement of biomedical science, and not on the practical application of existing knowledge. And it will — more than any other means I can think of — strip unnecessary costs out of the system over time without negatively affecting care delivery.
I’m a Republican, but I’m with Hillary on this one.
Quite simply — YES!!! We need to get better
at applying the tools we have, rather than
developing more and more new tools that
cannot efficiently, and effectively, utilize.
But you already said that — beautifully.
There is already an independent institute of best practices. It’s called AHRQ. It should take the lion’s share of NIH funding, but takes a teeny proportion.
Well, I guess you’re right (and Hillary as well), it’s really only just an agency.
I agree. But talk is cheap, and all this is, is talk. There are many holes in Hillary’s Universal Health plan. For instance, she assumes there are 47 million uninsured Americans every year. However, of those 47 million that are supposed to be uninsured, 10.2 million of them are non-citizens. Of the remaining 36.8 million uninsured, more than half were estimated to not be out of coverage for a full year in between jobs. When asked about Hillary’s plan not including any answer for these non-citizens or temporarily uninsured, Senior policy adviser Laurie Rubiner said, “We have not dealt with every single detail with this plan.”
Cary - Talk is not completely cheap. In many cases, it’s talk that turns a notion into an idea - and from there it becomes a proposal - and perhaps a policy. I’ve been talking about spending more money on the study of health care delivery for years - by myself. It’s only been in the past couple of years that a growing number of voices - policymakers, academics, politicians and others - have started to say - “Hey wait a minute! We need to spend more time and energy on applying what we know, instead of simply chasing the next new thing.”
So while it’s just all talk at this point, it’s starting to feel to me like a growing chorus of influential people are seeing this one the same way. And that’s a good thing.
I agree with you, Charlie to the extent that the higher priority in healthcare and therefore the better focus of spending is not “access” (i.e., paying others’ medical expenses), but improving quality significantly. Whether in private sector or public sector, Americans will support politically and pay for something that works well. For example, imagine if the aftermath of the war in Iraq had gone as dreamed by the White House - how many people would complain about the war today?
With due respect, however, an institute doesn’t guarantee best practices get put in place. The more difficult tasks are to find that mechanism and create a consensus behind it.
Charlie, With all due respect, you are scarcely the only person in health care who\\\’s been talking about spending more money on the application of what we know…and learning more about what works. Maybe that\\\’s true among your rarified peer group in this state, but while you and others have been talking, this train is far down the tracks in several other countries, including England. In the US, even when we do know, it\\\’s hard to actually make the changes because of our ridiculous and fragmented financing system. Much easier to do in a country that has a health care system. Even if we spend more on applying what works, what are the levers for change in this system?
Debate/communication is a wonderful thing, but there needs to be focused effort when it comes to current policy vs. coming up with another “new” idea to add to a growing list of proposed solutions. Talk is not always cheap, but I am tired of hearing opinions with no apparent follow up. It would be nice to audit current policy and see how we can better utilize what we already have:
- All individuals must have access to basic health services. Public and private programs should incentivize broad and consistent physician participation.
- Basic level of coverage should be clearly defined, periodically updated and adapted for gender and age. Coverage must emphasize preventive and supportive, as well as curative, services.
- Healthcare delivery system should provide safe, quality care that is EVIDENCE-BASED and resulting in appropriate outcomes for the patient. Services should be coordinated to assure continuity.
- Healthcare delivery system should be patient-centered and responsive to individual patient needs, preferences, culture and values. The delivery system should be transparent, and should encourage accountability by making appropriate information available to assist consumers’ decision making. The system should be equitable, and simple to understand and navigate.
- Healthcare should be affordable and there should be every attempt to avoid waste.
- Sufficient financing should be available to the healthcare delivery systems to meet long-term responsibilities for providing safe, evidenced-based and quality care.
- CONSUMERS INVOLVEMENT is key in creating a viable healthcare system (policy is influenced by consumer involvement). Consumers must fulfill an obligation to maintain a healthy lifestyle; take advantage of preventive care; and seek more advanced care when it can make a difference. Consumers should be offered incentives for being wise in their involvement and willingness to be pro-active in their care.
I agree with you, Charlie. If we only applied the simple principles that we already know - healthcare would be so much less expensive. However… just as those of us who are overweight know what we should be doing… there is a disconnect between knowledge and its application. So I would also like to add that we need to figure out creative ways to affect change in diet and lifestyle habits that underpin many of America’s chronic health conditions. We have to incentivize increased physical activity and healthy eating… and for those who need meds, we must help them become compliant. Those “simple” changes would also save tons…