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Economists Display What They Don’t Know About the Health Care Industry

Posted on October 7, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Recently, I resorted to a rare economic argument in a health IT article, pointing out that it’s unfair to put the burden of high health care costs on the patients. Now 101 economists have come out publicly recommending that very injustice. Their analysis shows the deep reluctance of those who are supposed to guide our health care policy to admit how distorted the current system is, and how entrenched are the powerful forces that keep it from reforming.

My argument cited numerous studies and anecdotal reports to show the deplorable record of the US health care industry regarding costs: providers who don’t reveal prices, providers who don’t know what the patient’s out-of-pocket costs will be, wrenching differences in insurance payments for the same procedure, missing quality information that consumers would need to make fair comparisons, and more. Just as icing on the cake, the most recent Consumer Reports (November 2015) offered a five-page article on all the screw-ups that lead to medical “sticker shock.”

Probably I’m foolish to launch an economic argument with the distinguished signers of the brief letter to key members of Congress. The signers’ credentials are impeccable, placing them in an impressive list of universities and think tanks–all of which, I’m sure give generous coverage for any health care these economists need. If any of the signers should be burdened with the Cadillac tax, they could cover it with an extra consulting gig at the World Bank. (What’s the economics behind “nice work if you can get it”?)

But the economists just aren’t facing realities in the health care industry. Let’s expand their telescoped argument, full of assumptions and leaps of faith, to see what they’re saying.

First, they expect that the Cadillac tax will not be quietly absorbed by firms wooing professionals in high demand (such as health IT developers), but will drive those firms to reduce coverage. The burden will explicitly fall on the individual patient. I suspect that many firms facing staff shortages would just compensate key high-performers for the high-cost health coverage, but let’s accept the economists’ assumption and move on.

Next, the economists assume that the patient will make rational choices leading to what they call “cost-effective care.” What could such choices be?

Can the patient tell her doctor that a certain test is unnecessary, or that a certain treatment is unlikely to improve her condition? Does the patient know that the test has too many false positives, or is unlikely to add to the doctor’s knowledge? These questions lie precisely within the expertise of the provider, not the patient.

Can the patient determine whether a high-cost drug will pay for itself in reduced future health care and improved quality of life? This calls for extended longitudinal research.

Can the patient tell her provider or insurer to adopt a rigorous pay-for-value regime? If she goes looking for an ACO, will it actually gather enough data to treat her efficiently, and does it truly get rewarded for doing so? These are nation-wide policy issues outside the patient’s control.

As I pointed out in my earlier article, the patients lack the information needed to compare the costs and quality of procedures from different providers. Patients try to do so, but data is inadequate. Nor will yelling and screaming about it make any difference–we’ve all known about the problem for years and it hasn’t made much difference so far.

I don’t like dumping on economists. After all, they rarely cause the problems of the world, and are all too often tasked with solving them. The perennial occupational hazard of the economist is to be forced to make recommendations on the basis of insufficient knowledge.

But in this case, the average patient has knowledge that these economists lack. The problems are also well known to anyone in the health care industry who has the courage and clarity of vision to acknowledge what’s going on. If we want the system to change, let’s put public pressure on the people who are actually responsible for the problems–not the hapless patient.

Online Reputation Management for Doctors

Posted on August 7, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As you know, I’m a sucker for an infographic. So, I couldn’t resist sharing this online reputation management strategy infographic for doctors that was posted by CureMD. There’s so much to chew on in this infographic, but my favorite part is the last image which shows the breakout of how people review doctors. It shows the physician reviews definitely skewing positive. What do you find interesting?
Doctor Online Reputation Management Strategies

Big Government, Healthcare IT, Our Healthcare System and the Economy

Posted on July 17, 2009 I Written By

There are a couple things going on in this country which are troubling. Two of them have to do with healthcare and the third has to do with our overall economy which is closely linked to healthcare.

Government is getting too involved with healthcare. First, they are rushing to mandate information technology (IT) which is not “ready for prime time”. Second, they are going to set up a government option for healthcare which will be subsidized by our tax dollars. This option will drive other insurance companies out of business (you can’t compete with a significantly subsidized competitor). There will then be a one payer system so we will no longer have choice. This system will be designed and run by government beurocrates (which I am not excited about) who we will be supporting through our tax dollars (higher taxes on everyone). Healthcare will be more expensive and less effective (See Medical Economics July 10, 2009, Critical Mass) AND this system will have a negative effect on small business and big business and our economy. Finally doctors will be affected in all sorts of ways (see Medical Economics July 10, 2009, Top-down, bottom-up, and medicine in the middle).

As we watch Obama and his advisors change our basic healthcare system and our basic economic system (from a small business model to a big government model), everyone should take some time to read Atlas Shrugged by Ayn Rand. The book is very long, so read the Cliff Notes!

What are your thoughts on all the changes going on right now, from the changes in our healthcare system to the mandates for electronic medical records. Who is going to pay for all this? Who is going to implement all of this? Is it going to work? Are we doing a big experiment (with our whole healthcare system and our whole economy) without doing smaller experiments to see what will happen?