Tag Archives: comparative effectiveness

Health Care Costs

The Downside of Comparative Effectiveness Research

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This is doctor Pauline Chen, writing in the New York Times:

While I now accept the constant presence of an invisible and powerful third party in my interactions with patients, I can still feel my shoulders tighten whenever I hear the word "authorization." But it is not the third party per se that causes the hairs on the back of my neck to rise. It is the sense that some of their decisions are based not on well-researched recommendations but on interests, agreements and circumstances that have little or nothing to do with good care.

Comparative effectiveness is not just a future phenomenon. It's already here. See below.

Medicare

How Comparative Effectiveness Works in Medicare

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This is from an editorial in the New York Times:

Medicare has proposed not to pay for so-called virtual colonoscopies because there is not enough evidence that they would benefit people aged 65 and older. That may be disappointing for older Americans who would prefer a virtual exam to a real one. But those sort of judgments will be fundamental to any successful health care reform effort.

Lest I mislead, I'm not against Medicare making these decisions. As a taxpayer, I have a self interest in not seeing money wasted. What I'm against is a monopoly health insurer, which gives patients and doctors no alternatives.

Physicians

Taking Another Look at Health Information Technology

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As part of the federal government's economic stimulus package, Congress has authorized spending about $20 billion on health information technology (health IT) and another $1 billion on comparative effectiveness research. These provisions achieved wide bipartisan support in Congress and in the health care industry, based on the hope that the investment will help improve efficiency, cut costs, and result in better care. The reality is likely to be far different.

Proponents of this spending rely heavily on a RAND Corporation analysis from 2005 that predicted $77 billion in annual savings and improved outcomes. RAND estimated "implementation would cost around $8 billion per year, assuming adoption by 90 percent of hospitals and doctors offices over 15 years." It said, "The benefits can include dramatic efficiency savings, greatly increased safety, and health benefits."

Unfortunately, RAND assumed an error-free system that is quickly and enthusiastically adopted by virtually the entire health care system. That might happen, but it is an absolute best-case scenario. Even then, instead of "dramatic savings," the $77 billion hoped-for savings amounts to a mere 4.5 percent of total costs, placed at $1.7 trillion by RAND. Continue reading Taking Another Look at Health Information Technology →

Health Care Costs

This Debate Needs More Adult Supervision

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Here is Joe Flower, writing at The Health Care Blog:

The forthcoming fight for real change in healthcare: It will be viciousness at the top of the lungs.  It will be a scorched-earth campaign.  Its main weapon will be fear. It will be unencumbered by any actual knowledge, subtlety, awareness of history, or access to the thoughts of people who actually know what they are talking about.  Its fury will be unloaded not just in service of narrow and inflexible political nostrums, but in the service of sectors of the industry which fear that a truly efficient and effective healthcare system would cripple their profit margins. The fulminating rages across Rush Limbaugh’s radio rants, Matt Drudge’s blog, the editorial pages of the Wall Street Journal, and commentaries issued by conservative think tanks, all echoed around the blogosphere.

And what, you may ask, provoked this hysterical diatribe? It was Flower’s reaction to his perceived conservative reaction to $1.1 billion in the stimulus package for “comparative effectiveness research.” I’ll explain why he is wrong below the fold. Continue reading This Debate Needs More Adult Supervision →