Tag Archives: chronic care

Health Alerts

Patients Managing Their Own Health Care Budgets

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Critics of consumer-directed health care often argue that patients are not knowledgeable enough and the market is not transparent enough for consumerism to work in health care. But a new study by The Commonwealth Fund says there is an international trend toward self-directed care (SDC) and it is focused on a most unlikely group of patients: the frail, the old, the disabled and even the mentally ill.

  • In the United States, Medicaid “Cash and Counseling” programs — underway for over a decade — allow home-bound, disabled patients to manage their own budgets and choose services that meet their needs.
  • In Germany and Austria, a cash payment is made to people eligible for long-term care — with few strings attached and little oversight on how the money is used.
  • In England and the Netherlands, the disabled and the elderly manage budgets in a manner similar to Cash and Counseling in the United States.
  • Also in this country, Florida and Texas have SDC programs for patients with serious mental illness and the Veterans Administration has an SDC program operating in 20 states for long-term care and mental illness.

And, as I wrote in an earlier version of this post at the Health Affairs blog, it appears that we have barely scratched the surface in taking advantage of patient power opportunities.

[Wait a minute. Aren’t we usually critical of Commonwealth Fund studies at this site? Yes, but CWF studies often come with press releases, hoopla, fanfare and the touting of public policy implications. I found this study back in the archives, covered with dust and mold, underneath stacks of other papers — figuratively speaking, of course — to be found only by the diligent and the tenacious.]

httpv://www.youtube.com/watch?v=T6ya7ZRlrEo

“I did it my way”

 

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Health Insurance

The Market for Chronic Care

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I have argued before that, but for third-party payers, a market for chronic care would have developed long ago. What do entrepreneurs do in every other market? They find people with unmet needs and figure out low-cost ways of solving their problems. Yet with a large and growing number of uninsured and a growing number of people with high-deductible insurance, markets for chronic care may develop anyway.

In several cities, Walgreens is offering pharmacist consultation to diabetics. (The service is free now, but there may be charges later; and, in any event, Walgreens is selling them drugs.) If it works, the program may expand to asthma, high cholesterol and obesity.

Health Alerts

Chronic Care

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By some estimates, more than half of US health care spending is for patients with chronic conditions. As I have previously reported, this money is spent very wastefully. Care is often delivered in discrete, disjointed and disconnected ways. The most efficient form of therapy (drugs) is substantially underutilized. And many chronic patients are not receiving care at all.

Fundamentally, there are two ways to deal with chronic care. The current approach is a nonmarket approach, and it has the following 10 characteristics:

  • Completely suppressing the market for every facet of medical care and every type of health insurance — so that no one ever faces a real price for anything;
  • forcing health plans to take enrollees they don’t want at premiums well below the cost of their care;
  • forcing doctors to treat patients with complicated conditions for the same fees as easy-to-diagnose-and-treat patients;
  • paying doctors in a way that encourages uncoordinated and unintegrated care;
  • denying providers the opportunity to repackage and reprice their services in ways that would lower cost and raise quality;

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