Tuesday, May 13, 2008

Health care: universal coverage? Try universal automated care coordination

In recent networking about various health and elder related issues, one point has become apparent to me about the health care debate. There seems to be a considerable potential for savings by much better integration of patient care. This is particularly the case with patients under Medicare and with those in many retiree health care plans, and probably some ordinary group plans.

Many plans sponsored by employers require “managed care” with the person selecting a primary care physician who must approve (or at least start the approval chain) referrals to specialists. The primary care physician (often a family practice or internal medicine physician) knows all of the medications prescribed. In Medicare, and in some retiree plans, patients are allowed to go any specialists on their own who accept Medicare or who accept the particular plan under contract. Often there is no systematic checking for medications, repeated (and redundant) tests or other therapies. The patient (or the patient’s family) is counted on for this information.

Conservatives have sometimes made a strong case for much better record keeping and sharing of information among providers. This may run into HIPAA-related issues, but there is almost no question that doing so could save considerably on Medicare and ordinary medical plan costs and claims. Liberals (and particularly the Democratic presidential candidates, particularly Hillary Clinton) have been talking about universal coverage and mandatory coverage, but they should also talk about mandatory automation of treatment coordination.

Civil libertarians may be concerned about the concentration of information, however. It could make it easier for governments to quarantine or isolate persons in the future should some now unknown communicable disease appear.

Picture: Amtrak's Union Station National Train Day.

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