Friday, October 26, 2012

Seven Causes of  High Health Costs: Left-Brain and Right-Brain Factors
Which of you, intending to build a tower, sitteth not down first, and counteth the costs, whether he have sufficent to finish it?
The Holy Bible: Luke
Currently, the United States spends more on health care services than any other country, exceeding $2.6 trillion, or about 18 percent of gross domestic product.  Most years, medical spending rises faster than inflation or the economy as a whole. Many factors - and nearly everyone- contribute to these increases.
 Julie Appleby,  “Seven Factors Driving Up Health Costs, “ Kaiser Health News, October 25, 2012
October 26, 2012  - In an excellent article,  Julie Appleby of Kaiser Health News identifies seven factors contributing to high health costs but no single villain.

1.      Pay our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient.
2.      We're growing older, sicker and fatter.
3. We want new drugs, technologies, services and procedures.
4. We get tax breaks on buying health insurance -- and the cost to patients of seeking care is often low.
5. We don't have enough information to make decisions on which medical care is best for us.
6. Our hospitals and other providers are increasingly gaining market share and are better able to demand higher prices.
7. We have supply and demand problems, and legal issues that complicate efforts to slow spending.
The Malpractice, Defensive Medicine Factor, and Scope of Practice Factors
Of the last factor, she says: “Malpractice premiums and jury awards are part of what drives spending. A larger problem, although hard to quantify, is ‘defensive medicine’ -- when doctors prescribe unnecessary tests or treatment out of fear of facing a lawsuit, the report says. Fraudulent billing or unnecessary tests by medical providers seeking to ‘game the system’ are another concern.”  (This is no doubt true. Defensive medicine may cost the system in the neighborhood of $50 billion to $200 billion.  No one knows exactly how much. Fraud is estimated at $60 billion to $90 billion).
“Finally, the report notes that state laws sometimes limit the ability of nurse practitioners or other medical professionals, who are paid less than doctors, to fully perform work for which they are trained. The U.S. faces a shortage of primary care doctors, so more advanced practice nurses and others will be needed to help care for patients who gain insurance coverage under the federal health law. Conversely, the U.S. has a higher ratio of specialists than other countries, which can serve to drive up spending. Specialists have more advanced training than primary care doctors, and are paid far more( To complicate matters, U.S. patients often prefer  to be treated by a specialist).
On Target
Julie is on target with her assessment.   What she is describing are the natural consequences of human nature under the current system and are difficult to reverse.
·         Doctors act in their own best interest to enhance their income,  Who, in similar circumstances,  would not?
·         We get sicker and thicker as we grow older.  Aging has consequences.
·         As patients we want the very best for ourselves.  And for our families and other loved ones.
·         We take advantage of tax breaks. Breaks are there for a reason,  and special interests  make sure they stay there.
·         When  costs don’t effect them,  patients  use more care, Why not? Someone else is footing the bill.
·         Information may not available to judge what is the best thing to do. And in certain cases  It may never be – individual patients respond unpredicatably differently, and nature and disease are slow to yield their mysteries.
·         Doctors and hospitals flock together to protect their turf and may end with virtual monopolies,  Like it or not,  this is a consequences of collaboration,  which some may prefer to call collusion.
·         We have a doctor shortage, and our legal system with the ever-present threat of being sued  leads to high costs of defensive medicine. After all, one must protect oneself against the accusation that one did not cover all the possible bases.
Other Factors - Left Brain and Right Brain Thinking
But there are other factors as well.   These factors tend to be unspoken, intangible,  subjective, and very human.
These factors boil down to  left-brain thinking vs. right brain thinking.   
Left-brain thinking is scientific, sequential, logical, and rests on piles of data.  Number crunchers, federal bureaucrats and others with green eye shades using computers,  information technology techniques, and electronic health records can easily compile,  sift, analyze, dissect, parse,  and compose evidence-based data, protocols,  checklists, algorithms, rules, and regulations purported to elevate quality and otherwise rationalize, and if need be,  ration care and costs.  But, instead, left brain rules, with the time-consuming demand  for data entry, bureaucratic hassles,  and concentration on an all-inclusive  chart, distracts from patients,  eats up time, and drives up costs.
The right brain, the design mind,  and the thinking it produces differs.  Its thinking is based on pattern recognition,  intuitive leaps, clustering and chunking to make sense of data, recognition of body language and verbal cues,  and the knowledge-based on experience with thousands of patients,  recognizes that the human condition is full of vast immeasurable gray  zones and personal conumdrums..   The right brain can cut through the morass of data and reach sensible and quick decisions without wading through regulations and procedures designed to rationalize care.   It humanizes care. It is an art based on doctor-patient relationships, and sometimes goes by the name of bed-side manner and human sense.   It is a trait shared by many superb diagnosticians and commonsensical  doctors who can inexpensively and quickly  reduce medical and health problems to their essence.
Tweet:  Multiple American  cultural factors drive up costs of care, and these factors do not always yield to data-driven and protocol -driven care.




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