Saturday, December 29, 2012
Transitioning from fee for service medicine and spending money where it does the most good
Physicians perform studies about whether a given medical intervention actually works, and whether, for what it costs, it is better than the intervention it seeks to replace. We have looked at the placement of stents in coronary arteries to treat or prevent heart attacks and have gained lots of information about which kind of stents are good for which kinds of coronary disease, comparing this technology to simply dilating arteries and looking at coating the stents with drugs that encourage blood vessels to stay open. This has at least given us information upon which to base what should be cost effective care.
But what about social programs? Giving a person financial aid, to eat, obtain housing, feed children, get medical care, is presumably for the purpose of improving health and happiness. But have we actually checked? Which social programs deliver the best result for the money? Could one public swimming pool prevent delinquency and save money on jail and public assistance? Could regular access to massage therapy save money of physical therapy or prevent orthopedic procedures? Could better training to prepare a person for work reduce devastating work related injury and associated medical costs?
It will be interesting to see how we make decisions about spending "health care" dollars as the dividing line between prevention and treatment of illness becomes blurred. If a community was given all of the health care dollars presently spent on caring for its members along with knowledge of which programs or services or projects made people healthier and so less in need of expensive medical interventions, effective prevention would be funded. It may be a bit of a trick to get data on what works. Perhaps it's time to start looking at this sort of thing more scientifically. I'm thinking about an article on the front page of the New England Journal of Medicine in some happy future time entitled, "Effect of ballroom dance classes and weekly social dancing on emergency room visits and admissions in elderly adults." Or perhaps, "Health outcome effects of regular home visits by a mobile primary care physician team." Or "Reduction in total joint surgeries in a community with publicly funded massage therapy and Tai Chi Chuan classes." The possibilities make me smile.