“Tom Bodenheimer caught the managed care dilemna neatly: “cost, quality, access — pick any two”. It was a sign he saw hanging on a wall in a West coast Medicaid HMO.”
My intent was to document the current state of Oregon Health Plan, the parallel between it health systems in Canada and the UK. I suspect a cautionary note could be gained from OHP’s struggles as this debate rages on.
In trying to find some recent articles, I came across something else.
I’ve been on the road again, and visiting friends as I head home from our nation’s capital. I’m leaving in a few short hours, so this will have to suffice for now.
It’s a worthwhile read, and highlights better than I managed the dangers of making health care too cheap.
It also highlights the problem with OHP, a quick Google search is quite edifying, but the gist is this: Oregon attempted to cover fewer (services), and cover more (people). It worked beautifully for a while (unless you were the one who’s life was risked with rationing). Now it’s failing on both counts.
Canada and UK both beat us coming and going on most measures of health care, and yet the costs there are also unsustainable. What is the commonality between our “private” system, and their “public” systems?
Ineffective funding.
Consumer driven plans are a good start. When patients have a limit of real money, and have to pay for the day to day stuff out of pocket, they are more careful with their health care dollars, they demand better quality care, and in a more affordable manner. They become more engaged in their health care, ask more questions, do more research, and don’t blindly follow the doctor’s orders. They are more invested in staying well.
The way I see it, we have very few options: the government can try to rein in costs by limiting access or limiting reimbursement. Neither model works particularly well.
Private insurance companies can try to manage cost… That’s not working well either.
We can have patients take on more responsibility for day to day costs, so they are more selective with health care utilization.
Frankly, my preference is always to empower the patient. I simply don’t trust the impact of either of the two other options.
My concern is the elderly (the proposed cuts to an already struggling Medicare and already struggling seniors in the worst recession in my lifetime worries me), the chronically ill, the poor.
Personally, I think consumer driven health plans are really the only way you get to pick all three. But they leave the most vulnerable folks even more vulnerable.
My suspicion is through tax incentives or other means, you could lessen the impact on those vulnerable groups, ensure them better access to care, and fair reimbursement to providers. That still leaves us with Fee for Service, but the suggestion of a federally-sponsored website where patients could track costs and quality might be quite useful, particularly if it incorporated a Health Grades type feature.
Whatever reform we get, we have to remember what it means to be a consumer. We have to remember the first thing we saved and strived for, the first thing important enough for us to delay gratification. Consumers need to be that vested in their health, and their health care, but not so invested in the overall cost that they delay care altogether.
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