How to Control Health Care Costs: Editorial from Medscape on WebMD

Medscape is the free service that provides information to the general public from the burgeoning world of scientific medical information. It includes highlights from key articles in a range of medical journals as well as timely commentary and discussions about the business of medicine. In March of this year, the video commentary by Karen Davis PhD contained, I thought, very insightful and practical suggestions for improving the quality and cost effectiveness of the US healthcare system. Since this will undoubtedly be one of the greatest challenges facing the profession and practitioners in the coming decades, the text of Dr. Davis' comments are reproduced below. Go to www.medscape.com/viewarticle/501813 to see Dr. Davis deliver this video editorial (you will have to submit a free registration with Medscape first if you are not already a member). For more detailed comments by Dr. Davis, go to www.cmwf.org/publications/publications_show.htm?doc_id=221624 for a summary of her recent testimony for the Senate Appropriations Committee on this topic.

How to Control Health Care Costs: Take a Walk on the Supply Side - Karen Davis, Phd

The federal government says that healthcare spending will double to $3.6 trillion in the next 10 years. ¹ There are as many expert opinions about what to do about that as there are experts. So, let me add mine.

Here's my "Top 10 List" of approaches that show promise for reducing healthcare costs and improving quality at the same time:

1. Prevent hospitalization by having nurses monitor patients with serious
   conditions at home ² ;
2. Reduce variation in charges for patients with similar conditions;
3. Encourage shared decision making by informed patients;
4. Stop paying for medical errors and poor care ³ ;
5. Negotiate pharmaceutical prices ⁴ ;
6. Standardize insurance products to reduce administrative costs;
7. Use evidence-based clinical guidelines to determine when a given test or procedure should be done ⁵ ;
8. See that every patient has a regular physician responsible for prevention, management of chronic conditions, and coordinating care ⁶ ;
9. Reduce waste and duplication of care; and
10. Implement modern information technology.

Combined, these efforts could generate substantial savings. None would force patients to forgo effective care or pay more out of pocket. The savings should be redeployed to help cover the uninsured, improve prevention and quality, reduce disparities in care for minority patients, and invest in modern information systems. The result? A health system that commits fewer errors, improves health, and is accessible to all. ⁷ And that's worth paying for.

That's my opinion. I'm Karen Davis, President of The Commonwealth Fund. Note: For a more detailed rendition on this topic, please visit The Commonwealth Fund , to contact the author .

Readers are encouraged to respond to George Lundberg, MD, Editor of MedGenMed for the editor's eye only or for possible publication via email: .

References

1. Heffler S, Smith S, Keehan S, et al. U.S. health spending projections for 2004-2014. Health Aff . 2005 Feb 23; [Epub ahead of print].
2. Naylor M. Making the bridge from hospital to home. Grantee Spotlight on Mary Naylor, Ph.D., R.N., F.A.A.N. Fall 2003 Commonwealth Fund Quarterly . Available at: www.cmwf.org/spotlights/spotlights_show.htm?doc_id=225298 Accessed March 21, 2005.
3. Wachter R. The end of the beginning: patient safety five years after 'to err is human.' Health Aff . 2004 Nov 30; [Epub ahead of print].
4. Anderson G, Shead D, Hussey P, et al. Doughnut holes and price controls. Health Aff . 2004 Jul 21; [Epub ahead of print].
5. Schoenbaum S, Audet A, Davis K. Obtaining greater value from health care: the roles of the U.S. Government. Health Aff . 2003;22:183-190.
6. Schoen C, Osborn R, Trang Huynh P, et al. Primary care and health system performance: adults' experiences in five countries. Health Aff . 2004 Oct 28; [Epub ahead of print].
7. Davis K. President's message: transformational change: a ten-point strategy to achieve better health care for all. Commonwealth Fund 2004 Annual Report. Available at: www.cmwf.org/annreprt/2004/msg_pres01.htm Accessed March 22, 2005.

Karen Davis, PhD , President, The Commonwealth Fund, New York, NY. Email:

Disclosure: Karen Davis, PhD, has disclosed no relevant financial relationships.

SOURCE: Medscape General Medicine. 2005; 7 (1): ©2005 Medscape

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