Saturday, March 8, 2014

Economic Changes in Health Care and the Economy

Our health system developed over the past four decades in a reactionary manner to meet the immediate demands of the time. During this same time science and technology grew so quickly we are now unable to afford these advances for all.

The affordable care act may increase access to more for advanced treatments. Because of the increased demand insurers themselves will increase the necessity for prior authorization according to their own set of parameters.  The ACA provides no guidelines for these standards. Undoubtedly in the name of equanimity these standards would apply to non-ACA as well as ACA patients.

In the past there was no overall plan to integrate reimbursement for health providers. The Affordable Care Act, attempts to modify this course, but also creates major challenges for the overall economy, national debt, and business expenses.
Many states have refused to participate in the expansion of Medicaid to cover some of the uninsured, despite federal subsidies for several years to fund the increased cost.

Our approach has been much like that of Henry Ford who created mass production and educated students for specific jobs. The object of public schools at that time was to produce workers for specific jobs.  

What has happened is the job market has changed radically.  How many college graduates can not find jobs in their chosen area upon graduation ? We have been educating students for jobs of the previous century, which no longer exist.  We no longer see vocational schools, no apprenticeships.  Certfication has become a lifeline for proving a skill, and education has become expensive as the educational-industrial complex has grown.

Economic productivity can no longer be measured by the number of widgets built, nor can reimbursement for health care continue to be strictly fee for service. True incentives should be available for innovation and creativity in deliverying more health care, while increasing quality of life and wellness.

There are several challenges to this paradigm shift. How do we measure  quality improvement or a decrease in quality. What are the metrics ?  One of the first measures imposed by CMS has been the readmisson rate to hospital within 30 days of discharge. Patient compliance is a nother measure being used in some often is blood glucose, blood pressure, weight, and medication complicance. What is the availability and use of patient education, tutorials, and appointment compliance?

A more accurate measurement may be the real measurement of clinical condition such as control of blood pressure, blood glucose, weight, pain control, ambulatory and functionanl ability.

Will there be a reward or improvement, and/or a penalty for failure to improve a measure?  What will the factor be for these changes?

Finally are these measures really necessary and/or will they be effective in improving quality or just another means of controlling cost?

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