Thursday, February 21, 2008

Future - 2020: Cost-Effective Medicine

It’s 2020. Cost-effective medicine has arrived full-bolt, or perhaps I should say full-byte. It’s health 6.0 - the era of universal e-visits, e-connections, and e-interoperability. Cyberspace intimately interconnects payers, vendors, patients, and physicians. Everything is intertwined, transparent, and standardized.

All doctors are salaried, thus eliminating perverse incentives of fee-for-service medicine. Medical records and personal health records are universal. Most medical practice is conducted off-site, online, realtime. Patients submit complaints and medical histories from home. Software guiding history-taking has embedded scales for judging depression, alcoholism, or psychological conditions. Blood pressure, heart and breath sounds, even blood chemistries can be measured remotely, using space-medicine techniques. Remote internet medicine has arrived. Nothing is left to chance.

In ordering procedures or tests, doctors practice flat-of-the curve medicine. Variation in use of health care used to be ubiquitous in the United States. Variation was attributed to differences in supply of medical resources; to identify and unidentified economic, social, and cultural factors; and to idiosyncratic beliefs of physicians. It was perpetuated by the parochial character of clinical practice. No more. All doctors now practice in one standardized common boat, rowing together towards Nirvana.

It was long ago established that most high-cost, high-ticket medicine didn’t produce cost-effective, quality results. Now a more robust scientific foundation for clinical decisions has dramatically cut variations.

Consequently cost of medical care has dropped from 20% of GNP in 2010 to 10% today, thanks to command and control health 5.0, governed from on high. And thanks too to ,

• Predictive modeling and artificial intelligence algorithms

• Electronic access to all previous records and a national interoperative health information system.

• Robust diagnostic support systems with access to the latest medical information system from around the globe.

• Universal cost-effective clinical protocols consisting created by pooled input from thousands of clinicians

• Strict adherence to “scientific-evidence based “medicine” whereby every clinical condition, even if wildly subjective, has a scientific basis.

• Never-never payment by government or health plans for events or complications, inadvertent or advertent that should never have developed in the course of the disease or its treatment.

• Minimization of costs from high-ticket items such as invasive surgical or vascular catheterization with device placement or imaging procedures.

• Omnipresent social technologies, enlightened consumers, and globalization of most cost effective health care approaches from around the globe.

• A public that is aware, sensitive, and responsive and that is rewarded for prescription compliance, and such good health behaviors as not smoking, staying thin, and constantly exercising.

• Cost-sharing savings among doctors and their employers because of the new efficiencies, standardizations, and paperless practices.

• Elimination of most doctor visits and hospitalizations except for the truly ill.

There is one final benefit of health 5.0. Little clinical judgment is required. Clinical judgment is now statistically based. As a direct result, U.S. health outcome statistics – on infant mortality, longevity, access to care, and, above all, cost of care – have soared. To great heights, surpassing those of any other nation.

Little human interaction is needed to achieve these results. Don’t worry. Your patients are only a data-click away, and together, with your feet planted firmly in statistical concrete, you can decide what needs to be done.

I have to stop now. My tongue is lodged in my check, and it’s painful.

1 comment:

ObGynThoughts said...

pheeww, thank God for the last paragraph...for a moment I thought you had lost your mind