Consultant. Vol. 50 No. 10

Best of the Blog

Perspectives on Health Care Reform: What’s to Be Done About Cost Containment?

October 6, 2010

Meet Our Blogger: Gregory W. Rutecki, MD, is professor of medicine at the University of South Alabama College of Medicine in Mobile. He is also a member of the editorial board of CONSULTANT and series editor of “Top Papers Of The Month.”

Since continuing technological advancements are going to add to rising costs (dialysis, for example, with more "baby boomers" coming of Medicare age), one has to wonder what the something is that "has to give" in the future. We will be seeing patients with psoriasis, renal failure, and advanced cancer—and considering the high costs of pharmaceuticals for those who can and those who cannot afford to take them. When should we begin to determine how much is more life worth? Since it is apparent that these rising costs cannot be sustained indefinitely, will we ration, will we stop and draw the line for some of these miracle drugs and the people who want to take them?

Pravin Shah said:
Expectation and cost need to be tempered with affordability and ultimate return in terms of gains in life expectancy, real quality of life improvement, and out of pocket expense.

Dorothy Talotta said:
I think it would be helpful if we looked to other countries for ideas on how to solve our health care issues. In the U.S., we spend a great deal of money on the salaries of C.E.O.'s of insurance companies and dividends to insurance company stockholders. This is money that we all pay in health insurance premiums. If we did not have the system of for-profit, private insurance companies that we have here, that money could all go towards health care. . . . Countries such as Canada, Great Britain, and others spend far less on health care than the U.S. does and yet their measures of health care quality such as life expectancy, infant mortality rate, etc. equal or, in some cases, exceed ours. While their systems might not translate seamlessly to the U.S., I believe we can certainly look towards the systems in place in these countries to help us in our situation.

John Dente said:
Everyone must realize that America is no longer a wealthy nation, and if the dollar wasn't the reserve currency this nation would be bankrupt. However, even with the dollar as reserve currency, the national debt cannot be sustained indefinitely. Along with this the population is growing older as the medical technology becomes more expensive, so the application of these technologies for diagnosis and treatment will have to be looked at more closely. An example is Provenge, a new vaccine, called a vaccine, because it helps stimulate the body's immmune response to prostate cancer cells, and prolongs survival by 4 months, costs about $93,000. Whether it is worth it or not is subjective; what is not subjective is that someone has to pay for it, and can anyone afford it.

Dr Rutecki replies:
Thanks to my 3 colleagues for some very insightful comments. Their suggestions are right on target. First, Great Britain already factors in quality and duration of survival after approving a specific treatment/pharmaceutical. They have an agency called the National Institute for Health & Clinical Excellence (NICE). People have suggested that we do the same (JAMA. 2008;337:137). NICE has decided some high-ticket items (eg, bevacizumab(Drug information on bevacizumab) for cancer) don't provide enough bang for the prohibitive buck. Second, this example not only verifies wisdom can emanate from other countries, but Holland's healthcare reform also jettisoned for profit approaches to healthcare. Finally, there are more sticker shocks coming, like the prostate cancer vacccine that may be as expensive and unfortunately as efficacious (a pun) as bevacizumab or cetuximab(Drug information on cetuximab).

For all the comments and Dr Rutecki's replies, go to the Primary Care Matters Blog
Join the conversation!

by Chagai Dubrawsky | October 24, 2010 2:39 PM EDT

"How to avoid the looming healthcare crisis?"wrote the editor of MD&DI (J.of the american society of producers of medical devices and device instruments.Nov 2007)

Http://mddionline.com/article/how-avoid-looming-healthcare-crisis.

Just by changing the direction of medicine to more PREVENTION,a forcasted saving in 2023 of 1.1 trillion

dollar,per year,in U.S.Also a projected saving of forty million days of sickness associated with seven major diseases per year in U.S. is forecasted for the year 2023.

This report is based on studies by G.E. global research

and the Milken Institute in Santa Clara Californ

I think that it can be done,what do you think?

Following the principle of:KISS(Keep it simple...).the crisis can be prevented.

BLOG FOR CONSULTANTLIVE

Send us your blogs! Contact us for more information if you are interested in writing a post or becoming a blogger.

TOPIC INDEX

Developmental/Genetic

Nutritional/Metabolic

ABOUT OUR BLOGGERS

	On Health and Mental Health Erik R. Vanderlip, MD, is a senior fellow and acting instructor in the University of Washington Department of Psychiatry. As a dually-trained family physician and psychiatrist, Dr Vanderlip is active in national health system redesign efforts with a particular interest in newer models of the medical home. He practices family medicine in a hybrid primary care clinic within a mental health center in Seattle.
	The HIV-AIDS Observer Rodger D. MacArthur, MD, is Professor of Medicine, Wayne State University, Department of Internal Medicine, Division of Infectious Diseases and Director and Site Principal Investigator, Wayne State University HIV/AIDS Clinical Research Unit.
	Speaking of Pain Steven A. King, MD, MS, is in the private practice of pain medicine in New York, and he is Clinical Professor of Psychiatry at the New York University School of Medicine, New York.
	Tales Doctors Tell David T Nash, MD, is Clinical Professor of Medicine at Upstate Medical Center in Syracuse, New York. The author of more than 250 peer-reviewed clinical articles, Dr Nash has practiced cardiology in Syracuse for over 50 years. He is a Fellow of the National Lipid Association.
	Primary Care Matters Gregory W. Rutecki, MD, is Professor of Medicine at the University of South Alabama College of Medicine in Mobile. He is section editor of the hypertension topic center on this web site.
	Practice Makes Perfect Pamela Wible, MD, pioneered the first community-designed ideal medical clinic in America. An expert in patient-centered care, Dr Wible helps citizens design cutting-edge clinics and hospitals nationwide. Her model is taught in medical schools and featured in Harvard School of Public Health's newest edition of Renegotiating Health Care. Dr. Wible is a medical reporter for the Oregonian, has been interviewed by CNN, ABC, CBS, and is a frequent guest on NPR.

FROM PHYSICIANS PRACTICE

Primary Care Can't Thrive Without Nurse Practitioners
Courtney H. Lyder, ND, May 17, 2013
With a projected shortfall of primary-care physicians, it's time for alternate solutions to patient care. Nurse practitioners are one logical remedy.

VWhat Physicians Can Learn from the Allscripts EHR Lawsuit
Marisa Torrieri, May 16, 2013
Lawsuit prompts question: What should physicians do to ensure they end up with a great EHR instead of buyer’s remorse?

Eight Ways ICD-9 Will Still Matter to Medical Practices
Brenda Edwards, CPC, May 15, 2013
What should your medical practice do with your ICD-9-CM book after October 1, 2014? Keep it.

Seven Ways Technology Can Speed Up Patient Collections
Cheyenne Brinson, May 15, 2013
Failing to adopt widely available billing and collections technology can cost medical practices big. Here's how to do it right.

Four Reasons Private Medical Practice is Becoming Extinct
Carol Stryker, May 15, 2013
It’s becoming increasingly difficult for private medical practices to thrive. Here’s what’s driving the trend toward consolidation.

Perspectives on Health Care Reform: What’s to Be Done About Cost Containment?

Join the Conversation