2. Why are physicians blamed for all the waste in the system?
3. Why is it the physicians’ responsibility to eliminate waste when they are not the cause of the greatest percentage of the waste?
“The amount of money spent on medical care is increasing faster than the gross domestic product (GDP), and the federal deficit is increasing.”
The initial statement assumes that the government deficit is increasing because physicians control government spending for healthcare.
This is only partly correct. The question I have is maybe patients should drive medical costs and not the government.
The government bureaucracy and the healthcare insurance industry has created this cost monster.
“Budget experts believe that the deficit cannot be reduced unless medical spending can be controlled. What role will physicians play in controlling health care cost growth? Are physicians even willing to play a role?
The RAND Corporation does not consider the waste of the government bureaucracy, the healthcare insurance industry’s excessive fees, the hospital systems’ excessive billings, nor the pharmaceutical companies excessive charges for medication. Not considered is the excessive waste that results from the forced practice of defensive medicine because of the lack of tort reform.
If all these issues were addressed, waste and costs would be markedly decreased. There would be no need to try to commoditize physicians’ medical decisions.
I cannot visualize success in trying to commoditize the physician’s decision-making processes.
The healthcare system should be consumer driven with the consumers owning their healthcare dollars and making their own healthcare decisions. The government must help teach consumers to make appropriate medical care decisions with their own money. The government could provide the money. It would eliminate all the bureaucratic waste and secondary stakeholder abuse because it would create a true marketplace driven by consumers and not an artificial marketplace driven by government inefficiency. Consumers must make their own medical care decisions and be responsible for their actions.
The authors of the article suggest that physicians have three options for participation in controlling healthcare costs. The problem is it assumes the burden for controlling costs are the responsibility of physicians.
1. "Physicians can do nothing."
2. "Health care can be rationed."
3. " Physicians take the lead in identifying and eliminating waste in US health care system."
4. (We have tried to lead.)
5. (President Obama has ignored us.)
“Physicians could define waste by assigning all services to 1 of 4 types of care—inappropriate, equivocal, appropriate, or necessary”.
This is subjective busy work that is destined to fail. It will also stifle creativity, thinking, problem solving and innovation.
Physicians try to practice evidence-based medicine. There are defects in determining best practices. In many cases the conclusions drawn from clinical results are inaccurate. It is arbitrary based on the bias of the experts picked to be the judges.
1.Inappropriate care, the potential health benefit to the patient is less than the potential harm caused by the procedure, device, or drug
2. With equivocal care, potential harm and benefit are about equal.
3. With appropriate care, potential benefit to the patient exceeds potential harm.
Necessary care is appropriate, represents the only viable option, and produces a large health benefit.
A tool to measure clinical waste across all clinical services does not exist. This is because the definition of “clinical waste” is ever changing. Today’s best practices can be tomorrow’s clinical waste.
Physicians are constantly trying to define best practices. It must be the job of physicians. Physicians are constantly trying to teach other physicians best practices. Physicians are constantly trying to learn to keep current.
The best practices have to be put into context with changing scientific concepts. Potential bias must be evaluated.
The clinical decisions should not be the interpretations of policy wonks or bureaucrats.