Saturday, May 31, 2014


The universal fall from grace is palpably reminiscent of Shakespearian times about the lawyers. “the first thing we do is kill all the lawyers” was the lament then. Well, no, not that bad really but it’s getting there for the doctors these days.  Nary a day goes by that the front page news does not bemoan the cost of healthcare and then with laser sharp vision of scrutiny and gnashing teeth of “reform” the anger spills over against the doctors.

The demographics are changing. Indeed most industrial countries like the United States, Japan and Europe have the baby-boomer population surging and the productive force of the 39-55 years declining. So much so that the retirees (over 65 years) will represent 20% of the US population in 2030 consuming more than producing. The current healthcare costs are 17% of the US GDP and slated to rise to 20% within the decade. The future is being foretold in the healthcare sector daily as the demand for care outstrips supply of dollars and the cost of that care outstrips everything else. This imbalance gives us all pause to reflect at what is and what might be.

There hangs a tale of two states: I know, I know comparisons are odious, but this is freaky!

China with its double digit growth feels its deflationary pressures as the GDP swoons a bit into low single digits.
Meanwhile due to the rapid expansion of its industry, the smog seems to want to choke the life out of its citizens.
Lung cancer rates are rising at an alarming rate there. But care for those unfortunate languishes within the totalitarian walls of bureaucracy.
No caption needed

This new found economic growth opulence is being balanced by the autocratic rigidity imposed on the doctors. The Chinese doctors are extremely unhappy about the conditions in which they practice medicine. They are dissatisfied with their overall conditions. Only 21 percent wanted their own children to become doctors. Interestingly, this survey showed that fewer than 10 percent of respondents blamed patients, doctors, or hospitals for their problems; the majority (83 percent) blamed “the system” for the tension between doctors and patients.” In a society used to the compelling nature of reliance on the state “from cradle to grave” the aging populace is waking up to the increasing out of pocket cost of healthcare.
They blame the poorly reimbursed, always on the hamster wheel doctors for the woes of their personal economics and blindly attack these physicians physically. Noteworthy there were 17,243 physical attacks on the physicians in 2010 and those numbers are increasing annually.
Chinese Doctors Protest conditions

In spite of the Chinese “deepening” level of reforms undertaken by the politburo in 2009 the conditions have worsened. The Chinese government’s reforms decided to pay the doctors through the agency of the hospitals. (Ah the irony of it all)! “The best way to increase doctors’ salaries is to put money in the hands of the hospitals that hire them; and the best way to do that is to make insurance coverage more comprehensive and liberal.”

The cost of that logic led to the following debacle: “Instead, most patients seek care from specialists in large urban hospital settings. Those hospitals are crowded and doctors have heavy workloads. Rarely are there formal appointments. Instead patients often have to navigate complex assembly-line care marked by long waits in a series of lines – it can take many hours in line to register then take care of prepaying one’s account, see a nurse then see a doctor, have tests performed then await the results, acquire a prescription then, finally, have the prescription filled.´”
Patients wait to enter the University Hospital in China

Meanwhile in the United States the Well Point insurer ostensibly through the aegis of its new found friend and technological associate IBM’s Watson came up with a solution to save around 3% to 4% of cancer treatment costs, which total around $5.4 billion a year for its fully insured business,” by using a $350 incentive per insured to the doctors for guideline-based medical care. In cancer, insurers and health-care providers have been developing treatment protocols—sometimes known as "pathways"—that are supposed to represent the best and most efficient approaches, balancing cost, benefit and side effects. Insurers are then paying doctors according to how well they comply.What they fail to address is, “According to an IMS analysis, average reimbursement for administering cancer drugs is 189% higher in hospital outpatient facilities than in doctors' offices.” Well Point and other insurers have looked at the facts and seem to think perverse incentives such as the $350 offered will help offset the costs in cancer care: “The U.S. spent more on cancer drugs last year—$37 billion, up 19% in five years—than any other category, according to the IMS Institute for Healthcare Informatics, a unit of IMS Health. Overall costs for treating cancer are well over $100 billion annually and mounting steadily, according to researchers at the National Cancer Institute.”

What it will do, if you think through a little deeper, is hamper patient care! With traditional methods of caring for cancer taking a back seat to the modern molecular targeted therapeutics the impetus to use cheaper drugs to make “the whole economic problem go away” will beset the industry with a larger problem of cost control versus patient care! The populace will demand the very best of what is out there in therapy and not getting it will bring with an unforeseen wrath. Meanwhile as time churns and with every turn of the screw the dissatisfaction in the U.S. doctors rises to mirror that of their Chinese counterparts, something will have to give! The conditions are rife with intermediaries reaping large profits and pointing the “blame” fingers at the doctors, for an upset in the marketplace.

The epistemological virtues of thoughts steeped in feckless premise of “throw money at the problem” never achieve the ends they seek. It is often the guileless caught in the cross-hairs of such vacuous punditry. The distractions used as impediments to reason will fall away to a questioning look-back from the hamster-wheel. The Eureka moment will arrive!

Maybe it is time to reconsider this whole process. Maybe doctor-patient relationship should go back to that rather than doctor-EMR-Insurer-government-patient relationship that exists today in the United States. Maybe skin in the game will bring the doctor and patients closer together. Maybe the word “care” will be from “caring” and not from “Medicare.” Maybe a hand on the shoulder will cure faster than an eye on the computer screen and frustration about reimbursements from an invisible employee of a large governmental/insurer organization ever will. And maybe, just maybe we will have the medical profession be the noble profession it once was.

No comments:

Post a Comment