Why We'll See a Boom in the Health Management Industry

I'm no futurist, but stats like these are hard to argue with...thanks to Dr. Stanley Feld, another one of my hard-hitting healthcare heroes, for the great post this morning (dated October 22nd, sent via email).

How about them apples:
  • Complications of chronic disease consume 90% of Medicare spending in the US.
  • There are approximately (estimates differ) 47 million people without healthcare coverage in the US - almost 1/5 of those have household incomes approaching $50,000 annually (according to a New York Times article).
  • Exhibit A: Complications of osteoporosis can be decreased 50% IF the condition is recognized and treated effectively - however, many HMOs and other insurance providers won't cover bone density studies for women under 60. Annual Medicare spending for complications of osteoporosis hits 21B. Why would docs do proactive DEXA scans when the average scan costs $134 (Lewin group study) and physicians will only be reimbursed $34 by 2010?
  • We're pushing both fiscal and actual 'responsibility' for health maintenance onto patients...witness the rise of high deductible plans and interest in self-pay "you're responsible" systems like the Netherlands. Sure, the government will help you out if you can't pay, but the onus is on you.
When will we wake up and pay for health management? Better yet, when will we wake up and pay for health improvement? When will an ounce of prevention be worth a pound of cure?

Will the civic provision of healthcare services ever be on a level with providing elementary education, municipal services like fire, police, waste removal, and infrastructure maintenance? We're all paying into the communal melting pot for various services - why not make a portion of healthcare spending one of those services?

Many are afraid the provision of 'universal' healthcare or socialized medicine would lead to the collapse of the private system, with a loss of billions of dollars in revenue.

Yes, some revenue would inevitably be lost, certainly initially (first 1-5 years following implementation).

But new streams of revenue would be available for capture, presenting business opportunities.

As a (so-called) market-based, capitalistic system, some organizations would rise to the challenge to make money.

Such a change may actually bring about the return of competitive pressures in the hospital/healthcare market, as consumers take their individual dollars where they want to be treated.

If we have to pay doctors, hospitals, physical therapists, acupuncturists, etc. directly, we learn the real cost of our health. Then we learn the real value of prevention and health management.

There IS an industry model in which both public and private entities have successfully flourished, and even compete for the consumers' dollar: the higher educational system.

Public and private universities both do a booming business. The federal government effectively subsidizes some percentage (albeit very small and rapidly shrinking) of a student's education according to their ability to pay - just ask anyone who has to file a yearly FAFSA to apply for student loans/grants. The federal (and state government) also subsidizes some of the cost of that education en total, by funding a portion of the school's operating costs directly.

Yes, we've all asked these questions before. There's nothing new in this post. Except perhaps this example:

For one of my husband's recent Lab Corp tests (see this posting for background), the total charge of the procedure was $119.

CareFirst BlueCross BlueShield itemized the $119, less a "non-allowed" amount of $94.02.

Total payment for the claim? $24.98.

Let's see that number one more time: $24.98.

It's the last line that's priceless. It reads:

"The Total Patient Responsibility Is.......... $0.00"
(This Is The Amount The Provider Can
Collect From You For These Services.)

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