4 questions for: Megan Gray, MD/MPH Candidate 2011
1-What do you think is driving up health care costs so much?
1) Insurance companies- the very nature of inserting a middleman creates often unnecessary jobs, time, and paperwork. compare the example of Ontario’s 900-bed general hospital with Mass Gen’s 900-bed hospital… Ontario has 3 people in the billing department, while Mass Gen has 300… so really it’s a bunch of kind of false jobs created that are taking up resources. For-profit insurance companies also drive up health care costs, as well as pharma companies that claim to increase costs to pay for R&D, but really spend too much on marketing/pushing drugs to doctors.
And if you want to get philosophical, Americans aren’t used to a patriarchal healthcare system… but this seems to work well in other developed nations. Americans would probably do better with less choice for insurance plans… although Germans have 240 “sickness funds” to choose from.
2-Dr. David Brailer, former national coordinator for health information technology in the Bush administration, in evaluating Wal-Mart’s upcoming Electronic Health Records plan, states that “If Wal-Mart is successful, this could be a game-changer” (see http://healthcareinformaticsblog.wordpress.com/2009/03/11/wal-marts-electronic-health-record-plan-could-be-a-game-changer/) Do you agree?
Wal-Mart would absolutely be a game changer- I noticed how freaked out physicians got over losing some autonomy to Wal-Mart’s hugely successful in-store clinics when they started, run mostly by nurse practitioners… a lot of the recent TMA (ed. note: refers to Texas Medical Association) discussions have been about limiting these types of clinics… Wal-Mart is enormously savvy in the healthcare sector and in that respect, proved they knew their clients… so with the EHR endeavor, they’re again proving they know their clients- just about every small town has access to a Wal-Mart, so small town/suburban doctors can easily access the system from a source/name they trust, with a store presence in case they need assistance… rather than a traveling IT salesperson coming into their office and then retreating to headquarters back in Dallas or New York… so yes, Wal-Mart plays a huge role in the industry.
3-When all the smoke is cleared from the policy battles over the level of access the insurance industry will have to patient EHR/EMR, do you think there will be more, not less, successful denial of coverage for policyholders by the insurance companies, based on data-mining for evidence of patient pre-existing conditions? Is the HIPAA Privacy Rule adequate to protect patient privacy?
I would think less since the nature of EHR allows for more standardization of practices/commonalities across patient cases, and a better electronic trail to document just why a claim was denied.
Another point: insurance companies might be wary of too much data mining, in case of a public backlash and an industry shift to phase them out so as not to worry of data mining at all… if we expanded a national system like Medicare to cover everybody, pre-existing conditions would cease to exist at all…as a greater risk pool would decrease the cost to insure any one member.
4-Where are the low-hanging fruit in the healthcare system that could keep costs from rising further, if any?
I really think that moving to an EHR system would help us contain costs better… not exactly low-hanging, but inevitable… and all the medical students I talk to can’t imagine using paper records in their careers, after having grown up with info so readily accessible online. Hopefully in the next few years it will take to implement such a system, the 60-65 year old bracket of old school anti-EHR docs will be on their way out…
A lso, practicing defensive medicine grossly exaggerates our use of labs/tests… for example, in Britain, doctors come up with the most likely diagnosis and begin to treat that… if there is no resolution, they move on to what’s next most likely on their differential diagnosis list. here in the U.S., docs are so fearful of litigation that they must order CTs and MRIs and extra labs from the outset just for the rule/out… for it’s better to spend a couple hundred extra now than risk thousands of dollars if you don’t seek out extra problems.
Also, pharma drugs- I wish there could be some type of legislation to limit the amount of marketing $ each company could spend… a national healthcare plan could also negotiate better bulk rates on drugs, similar to the dirt-cheap rate the VA gets now… I know lots of people who get prescriptions from Canada because the exact same drugs are literally 1/2 the price…
(in the interests of full disclosure, the repsondent is a family member)