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Health Cost Issues

If you pick up a newspaper or listen to anyone running for office, you will hear about spiraling health costs. Unfortunately, many of the attempts to reduce costs have been simplistic and targeted at what is easiest to control -- raising insurance premiums, cutting reimbursements to physicians or other health professionals, and reducing services.

Usually you will also hear in those comments about cost, words like 'quality care'. Many of these approaches are spurred by government or insurance attempts to force reduced medical spending as if quality and cheaper are the same thing. These programs may be doctor rankings by insurance, pay-for-performance programs, etc. Over the past 15 years or so, insurance companies have frequently used contracts with some primary care physicians in which they are awarded a bonus for not referring out to specialists.

Fortunately there are efforts to truly combine better quality as a way of reducing costs. One such organization that develops quality and safety programs is the Institute for Healthcare Development.

Missing from most conversations about reducing costs are things like, profits of insurance, pharmaceutical companies and hospitals, defensive medicine, and even more important, the increasing costs due to increasing obesity and resulting cardiovascular disease, and chronic diseases like diabetes. Non-compliance with care plan and medications for chronic disease are one of the drivers of increasing costs. We are responsible for reducing costs by our own behavior as much as corporate healthcare is responsible for theirs.

How can we better improve quality and control spending in ways that are ethical and just?

Here are some articles about drivers of heathcare spending and other health cost issues:

Ethical Challenges in the Delivery of Health Care Index:
Hospital based integrated delivery systems and the harms to physicians and patients. Florida Hospital-Adventist Health-Florida Physicians Medical Group (now called Florida Hospital Medical Group, FPMG).

Part 1: Concealed Ownership/Employment of Physicians
Part 2: The Power of Patient Steering by a Large System
Part 3: Negative Impacts on Physicians and Patients
Part 4: Community Need vs. Capturing Market Share and Revenue

Our Testimony to House Ways and Means Committee on Physician Reimbursement
Read the section specifically related to drivers of health costs.



As always, I welcome your constructive comments and suggestions about the material on this website and how we can all be most effective in co-creating the kind of healthcare system we all want.
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© Dawn Lipthrott, Ethical Health Partnerships, 2007

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