Issues with health care can be complex to work out

Issues with health care at a glance

A user writes:

There are several issues with healthcare at a macro level:

1) Costs of overall care is increasing. This is mainly due to utilization.

2) Reimbursement on a RVU/RBRVS basis is decreasing.

3) More people are getting older (baby boomers)

4) There are less care givers now and the trend is toward this worsening.

The answer is that not everyone will get all the care they want over the long term with the current approach to healthcare. Think about this, the system is out of whack. Physicians have implemented ancillary services to make up for their reimbursement deficiencies. AKA, a primary care group puts in a lab. Once done, they order a lot more labwork. As such, we have a cold war, so to speak of cost containment versus utilization.

In order to combat this, you need a force on the other side to contain the costs. In a free market economy, the market would provide this role. We are not in a free market. The patient does not pay the costs directly and this level of indirection has created a dysfunction in the market. If we go to a single payor, then they could provide this containment. This is unlikely due to political constraints.

As such, what is likely to happen is two things. Under the current administration, there is likely to be progress made on insuring the uninsured. While it will be our tax dollars paying for this, the government will feel the burden over time as costs continue to escalate. So, the government will have Medicare, Medicaid and the 40 Million uninsured. So, they will be a great force for containment.

On the private side, businesses are likely to continue to move towards plans that cover more catastrophic problems and will leave a great deal of the rest of the care to the patient as deductibles, coinsurance, out of pocket and copays. The effect of this will be that there will be market forces operating at a retail health level. It is my believe that this will spark a revolution in healthcare in terms of patient centered management. This will reduce costs, improve efficiency and improve outcomes dramatically.

The other very large component of the situation is the resources problem. Without enough care givers, what will happen? There are not a great number of choices.

1) You can get more care givers.

This will not happen quickly in the US. Medical schools are full. How long does it take to start a new medical school and produce care givers? It is a long time. And, this is at time when the dollars a care giver will make are decreasing.

You can bring in care givers from outside the US. This will happen, but this is finite also and the locations where they can come from also have exploding populations.

If we were to think of banks and tellers, what happened? They replaced tellers with ATM’s and made their customers tellers. This could happen with Healthcare in that patients, patient’s families and patient’s friends may very well be called in to serve in some roll.

To support all of this will be technology. NOT EMR. EMR is a disaster waiting to happen, but that is another subject. The technology will be mechanisms to allow remote care, remote monitoring and support to non-care givers.

Lastly, a great consequence of the declining reimbursement and the containment forces will be massive consolidation. Physicians groups will merge and/or be purchased by large organizations, including hospitals. The days of the small groups are numbered. There will be a Big Box approach to healthcare over the long term.

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