nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Sunday, November 7, 2010

Study: People Using Less Health Care

Many would jump to the conclusion that it's because of the economy.  But there are other factors.

I saw this article in the Wall St Journal Health Blog (Oct 29).  Americans sought health care with less frequency in the most recent calendar quarter.
The utilization slowdown could ultimately be a good thing as the nation grapples with how to bring runaway medical spending under control. But how good this is for consumers is an open question. But public health experts could grow concerned if it leads, for instance, to Americans cutting back on preventive visits and immunizations, which carry an upfront cost but wind up decreasing spending in the long run.
Naturally, we wouldn't want people to avoid care when they have potentially serious problems, or to experience increased pain and suffering from treatable problems...because of money.

To my knowledge, in this study, no one examined subgroups of the population to see whether the effect was more pronounced in those patients who have co-pays or deductibles.  If the reason for less health care is financial, one would expect that there would be no impact on those patients in mid-income ranges who have insurance plans with no deductibles or co-pays.  That wasn't done.

You might say, "How stupid is that.  Of course it's about money.  What else could it be?"  But, actually there's some research that says people seek health care excessively when there's no price to pay.  And studies that show reduced patterns of care-seeking need to go farther than just assuming it's due to money.
Reformers who want to implement a system that makes sure all who need care can get it, approach this in one of two ways:  they promote universal care, and (1) just accept that there will be those who use the system to excess--a cost of  ensuring universal coverage, or (2) they control access so that those who access the system too often are squeezed out by triage.

HCR in the US is approaching universal coverage using the first strategy.  As other universal care systems have experienced, costs will become prohibitive and mechanisms will then be put in place to reduce "abuse" of the heatlhcare system.  In Europe, this is done by providing primary care for free up to a certain limit, then a co-pay kicks in (I think France has the best example of this), or a voucher system for care that, when used up, transitions to a partial-pay system (the government bills the patient).

And there is the third option, which the British seem particularly fond of:  reduce costs by cutting certain kinds of care, or disallowing coverage for certain expensive treatments that don't meet arbitrary criteria for how much benefit they provide.  How draconian this approach can be is illustrated by the serious consideration the UK gave to eliminating all hip replacements for one year to save several million pounds.  The logic was that those who need hips could just continue to treat their pain and disability using drugs and crutches, etc., for that period, so money would be available to fund the rest of the healthcare system.

As a goal--an ideal to be sought after--universal healthcare is laudable.  But ideas have consequences.  If we don't think this through and do it right, some of those consequences will be unintended and undesired.

Doc D

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