Rationing by Committee
The committee has authority under state law to determine which medical devices and procedures Washington [state] will cover for state employees, Medicaid patients and injured workers, about 750,000 people in all. [The] process is public and open [and] it explicitly considers the cost of treatments in making its decisions, akin to Britain’s National Institute for Health and Clinical Excellence.
An editorial in one medical journal in the pain-control field equated one of the committee’s decisions to waterboarding and other forms of torture.
See Wall Street Journal editorials here and here on the debate over coverage for home glucose monitoring for child diabetics.
Amazing that they are considering not covering glucose testing when the 20 year old DCCT proved that good control controls and prevents complications. How do you get good control – by testing and matching your carbs with insulin. I guess under Obamacare cost will trump quality.
This is probably a trend that will increase in the future. In Consumer markets, buyers make decisions. In markets where third-parties pay 88% of medical bills, some other rationing mechanism besides price rationing must be used to limit utilization. That is the secret patients don’t seem to understand. If they demand more control over their health care dollars, they will have more control over the types of goods and services they receive.
Suddenly you realize some impersonal committee has compete control over your health and your life.
Doesn’t sound very inviting.
Someday this blog will actually show some respect for the truth. There’s the standard glucose strip testing and continuous glucose monitoring. There’s no question about the benefits of the standard strip based glucose testing and the Washington State committee reinforced that view with an 11 to 0 vote. Its also true that the only provable benefit of continuous glucose monitoring is in increasing the bank balance of the companies selling the units, the committee voted against them by a 10 to 1 margin.
Don’t stop believin’ artk.
I think I’ll push the boat out further in the direction Devon Herrick launched us. My investment of a few minutes of research tells me that the finger-strips cost up to about $1 per day and that the suppliers distribute the meters for free (i.e., a “razor-blade” business model). The lady in the NY Times article said that her boy had to test seven or eight times a day. The continuous monitors, on the other hand, cost over one thousand dollars, plus about $35 for a sensor with a 3-day lifespan. That’s a hefty difference in marginal cost.
The larger question, to which I think Dr. Herrick was leading, is “Should this be covered by insurance?”, to which I think the answer is no. (I expect responses suggesting that if diabetics do not monitor their blood sugar, they will have higher overall medical costs, ergo they should be covered.)
But it’s not actually “coverage” that these people want; it’s subsidy. If you gave the diabetic Medicaid patient vouchers worth, e.g. $7 per day in the case cited above, his family would decide which technology to use.
@ John Graham
Good comment.
See Avik Roy’s commentary on thie issue here:
http://blogs.forbes.com/aroy/2011/03/23/how-comparative-effectiveness-research-gets-corrupted-by-politics-2/?utm_content=Apothecary+Weekly+Digest+-+Forbes.com&utm_source=The+Apothecary&utm_medium=email&utm_term=post-link