Cost of care should be fo­cus of re­form

The Oklahoman (Sunday) - - OPINION - BY TONY PERRY Perry, who grew up in Ard­more, lives in Lon­don where he works as a pro­gram man­ager with the English Na­tional Health Ser­vice.

As the U.S. Se­nate ex­plores its op­tions for re­plac­ing the Af­ford­able Care Act, Repub­li­cans are find­ing “re­peal and re­place” harder than ex­pected to de­liver. Much of their fo­cus has been on hot-but­ton is­sues such as ex­pand­ing Med­i­caid and sub­si­diz­ing in­sur­ance pre­mi­ums to re­duce the prices peo­ple pay to get health care. How­ever, like the ACA be­fore it, this treats a symp­tom rather than the un­der­ly­ing dis­ease. Even with sub­si­dies, in­sur­ance pre­mi­ums will con­tinue to in­crease un­til pol­i­cy­mak­ers ad­dress the ris­ing costs of health care de­liv­ery.

The in­sur­ance pre­mi­ums peo­ple pay are di­rectly linked to the cost of ser­vices peo­ple con­sume. By pur­chas­ing health in­sur­ance, peo­ple spread the costs of their care — and that of oth­ers — into “risk pools” that are de­signed to make it eas­ier to bud­get for fu­ture health care costs and pro­tect against the fi­nan­cial dam­age of cat­a­strophic events such as a heart at­tack or a car ac­ci­dent. This works well for un­ex­pected ill­nesses or ac­ci­dents, but not for man­ag­ing the long-term con­di­tions that more and more Amer­i­cans face. Long-term con­di­tions worsen over time and re­quire more health care, which in­creases costs and raises in­sur­ance pre­mi­ums.

While sen­si­ble changes are needed around the costs of in­sur­ance, changes also are needed around the costs of health care de­liv­ery. For ex­am­ple, re­search by the In­ter­na­tional Fed­er­a­tion of Health Plans shows that a coro­nary by­pass in the U.S. costs, on av­er­age, $78,318, com­pared with $24,059 in the United King­dom and $14,579 in Spain. Higher costs aren’t trans­lat­ing to bet­ter health out­comes; in fact, deaths from con­di­tions treat­able by health care are higher than in any other de­vel­oped coun­try. Amer­i­cans are not get­ting the care they’re pay­ing for.

Ul­ti­mately, this means providers will need to work dif­fer­ently and make dif­fi­cult choices. For ex­am­ple, hos­pi­tals could re­place pri­vate rooms with gen­eral wards or treat pa­tients us­ing re­mote con­sul­ta­tions. Doc­tors and nurses will also need to re­con­sider their ex­pec­ta­tions around com­pen­sa­tion, so that pay is in line with lev­els paid in other de­vel­oped coun­tries. This is a bit­ter pill to swal­low, but it will lead to other changes such as low­er­ing the costs of train­ing med­i­cal pro­fes­sion­als, re­duc­ing the bu­reau­cracy that dis­tracts from pa­tient care and re­cruit­ing clin­i­cians from other coun­tries to fill gaps. Ex­ec­u­tives and ad­min­is­tra­tors should also re­con­sider their fi­nan­cial ex­pec­ta­tions; health care is fun­da­men­tally a pub­lic ser­vice and pay should re­flect this. Phar­ma­ceu­ti­cal com­pa­nies will need to change how med­i­ca­tions are priced and likely ne­go­ti­ate with state and fed­eral agen­cies.

Amer­i­cans, as users of health ser­vices, may also need to change their ex­pec­ta­tions. Pa­tients may find them­selves stay­ing in a ward rather than their own room when in hos­pi­tal; see­ing a nurse rather than a doc­tor for rou­tine con­sul­ta­tions; and pos­si­bly wait­ing longer to have a test or pro­ce­dure done. Pa­tients may find them­selves hav­ing less choice and re­duced ac­cess to the lat­est tests or med­i­ca­tions. Changes such as th­ese are nec­es­sary as the Amer­i­can health sys­tem trans­forms from de­liv­er­ing ser­vices to those who can af­ford them to pro­vid­ing high-qual­ity care to those who need it.

The im­passe in Congress may yet give hope to Amer­i­cans want­ing bet­ter, more af­ford­able health care. If politi­cians take a step back and fo­cus on the costs of care, they will find more op­por­tu­ni­ties to de­liver last­ing re­forms.

Tony Perry

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