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.
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.
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.”
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.
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