Thursday, October 16, 2008

Reader's Digest suggests pragmatic steps to control health care costs

Reader’s Digest has a practical essay on health care on p 124 of the November 2008 issue, “18 Big Ideas to Fix Health Care Now: This Won’t Hurt a Bit”, link here.

It starts by focusing attention on “the big five” (coronary artery disease, congestive heart failure, asthma, diabetes, depression), with preventive care. It moves on to suggest the use of walk-in clinics such as CVS’s “One Minute Clinics.” It claims that most childhood obesity could be eliminated with greatly fat-and-sugar-reduced public school meals. It talks about electronic medical records (under HIPAA). It is a surprisingly clumsy for physicians to get a new patient’s records from other locations. For example, I was never able to get all the medical information from my 1998 hip fracture in Minnesota brought back here in time to get a USPS job in 2004. That’s a system failure, and should not happen.

Another change is to stop unnecessary treatments. We all know that physicians order extra tests out of fear of malpractice. The dental area is important here. Dentists often talk their patients into spending much more money than is necessary. Not every chipped tooth needs a crown.

Medicare patients should have case and referral management by primary care physicians in a manner similar what is expected by employer group plans.

Use of university or teaching medical clinics could also be useful in cutting down costs.

All of this has to do with how medicine is delivered, more than how it is paid for.

Update: Oct. 18, 2008

Another important point, lost in all the debate: When people lose their jobs and health insurance and then exhaust COBRA in eighteen months, they are supposed to be eligible for health insurance regardless of pre-existing conditions for two years, according to HIPAA, the Health Insurance Portability and Accountability Act. This point was made on CNN this morning. Pre-existing conditions are a major issue in the health care policy debate. We'll track the details later.

The CDC's report on the influenza vaccine for 2008-2009 is here. The recommendations for vaccine recipients have expanded. There is some talk in the media that we are getting closer to some meaningful protection from H5N1 and I'll check more into this.

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