Profit Motif in Health Care

As I approach that age when Medicare is available, I am becoming very aware that the system is in desperate straits. The funds available for care are inadequate for present patients, and I hear about doctors turning away Medicare patients because they can't pay the fees the doctors routinely charge for services.

A study released yesterday gives a bleak view of the medical profession, once again reminding me that Dr. Professor Wombat warns often in our chats at eschaton that profit is not an impetus to quality of service in the medical professions.

Medicare costs vary wildly across the country, according to a study that found the government paying twice as much for treating a patient in Miami as in San Francisco.

The dramatic cost differences don't appear connected to climate or to who lives where, and people in the more expensive areas don't get better care.

More expensive medical technology is only part of the picture, according to the report released Wednesday by the Dartmouth Atlas Project, which studies medical resources. The findings were being published in the New England Journal of Medicine.

The study said the differences in spending from one area to another can be blamed on decisions made by individual doctors who are influenced by what medical services are available nearby.

"Technology doesn't drive the growth in health care spending, people do," said Dr. Elliott Fisher, the lead study author and a medicine professor at the Dartmouth Institute for Health Policy and Clinical Practice.

Fisher said physicians are not the only issue, but also questions like whether there's a local medical health race among local hospitals or whether a community has a single hospital that is more focused on primary care.
(snip)
The Dartmouth Atlas findings, drawn from an analysis of government Medicare data from 1992-2006, suggest great inefficiencies in care in some parts of the country. It also says there is plenty of room for reform if practices in the regions of the country that are less expensive could become the national norm.

That won't come easy since the country's medical system frequently rewards expensive practices, the study notes. For example, hospitals lose money if they improve care in a way that reduces admissions. Doctors don't have a financial incentive to spend time carefully listening to a patient rather than quickly referring them to a specialist.

"There are no financial rewards for collaboration, coordination or conservative practice," the study said.

As medical expenses have constituted the cause in about 50% of bankruptcies in this country, the need to restrain those costs is very obvious. Those of us who don't have work provision of insurance are well aware that we are paying exorbitant rates for what may be pretty poor service if we ever need it.

The review of medical care in this country now being performed under President Obama's instigation needs to take a close look at elements driving up costs without any benefits in better service. The U.S. should exit from its present role of the only country among 'civilized' nations that lets its citizens suffer the lack of health care. Bringing our health system into a role of protector of U.S. citizens, from its present role of taking advantage of us, would be a good beginning.