November 2007
Shortchanging the basics
Health-care costs are ballooning partly because the system is geared toward providing expensive interventions and remedies
after health problems develop. "We don't have a system in this country that rewards sitting down with people and educating
them as to why it's important for them to change behavior so that they're more healthy," said George Isham, M.D., medical
director and chief health officer for HealthPartners, a nonprofit Minnesota HMO whose primary-care doctors were rated better
than average in our September 2007 Ratings of HMOs and PPOs.
Isham chaired an Institute of Medicine panel that capped a years-long examination of American health-care quality by recommending 20 "priority areas" for action. Most had nothing to do with new drugs, high-tech care, or costly tests. Instead, the panel looked at basic prevention and care management, such as teaching people with asthma, diabetes, or high blood pressure how to monitor and manage their chronic conditions and making sure all children get timely immunizations.
With all the incentives running the other way, that's a tall order.
Historically, doctors who specialize in the types of care the Institute of Medicine recommended--family doctors, pediatricians, and internists--earn much less for interacting with patients than specialists who do procedures that take the same amount of time. This pay gap has persisted, for economic and political reasons, despite repeated efforts to reduce it.
New medical school graduates, often saddled with six-figure student loans, are increasingly opting to forsake primary care for the bigger paycheck they can earn as specialists. That compromises care quality; the Dartmouth research has shown that care suffers and cost goes up in regions that have a higher proportion of specialists.
"In other countries, people have a 'medical home,' a family physician they've been with for a long time, so the simple things get dealt with quickly and early on," said Karen Davis, Ph.D., president of the Commonwealth Fund, a private foundation that supports health-care system research. "We put a lot more money into the high end, where the payoffs are less."
As a consequence of a payment system that discourages prevention and management of care, Americans spent almost $29 billion on 4.4 million hospital stays for potentially preventable conditions in 2004, according to a study sponsored by the federal Agency for Healthcare Research and Quality.
What you can do. Take lifestyle changes seriously, especially if you are at risk for heart disease, stroke, diabetes, or cancer. If you have a chronic disease, work with your doctor to devise a plan to manage it.
Health-care costs are ballooning partly because the system is geared toward providing expensive interventions and remedies after health problems develop. "We don't have a system in this country that rewards sitting down with people and educating them as to why it's important for them to change behavior so that they're more healthy," said George Isham, M.D., medical director and chief health officer for HealthPartners, a nonprofit Minnesota HMO whose primary-care doctors were rated better than average in our Ratings of HMOs.
Isham chaired an Institute of Medicine panel that capped a years-long examination of American health-care quality by recommending 20 "priority areas" for action. Most had nothing to do with new drugs, high-tech care, or costly tests. Instead, the panel looked at basic prevention and care management, such as teaching people with asthma, diabetes, or high blood pressure how to monitor and manage their chronic conditions and making sure all children get timely immunizations.
With all the incentives running the other way, that's a tall order.
Historically, doctors who specialize in the types of care the Institute of Medicine recommended--family doctors, pediatricians, and internists--earn much less for interacting with patients than specialists who do procedures that take the same amount of time. This pay gap has persisted, for economic and political reasons, despite repeated efforts to reduce it.
New medical school graduates, often saddled with six-figure student loans, are increasingly opting to forsake primary care for the bigger paycheck they can earn as specialists. That compromises care quality; the Dartmouth research has shown that care suffers and cost goes up in regions that have a higher proportion of specialists.
"In other countries, people have a 'medical home,' a family physician they've been with for a long time, so the simple things get dealt with quickly and early on," said Karen Davis, Ph.D., president of the Commonwealth Fund, a private foundation that supports health-care system research. "We put a lot more money into the high end, where the payoffs are less."
As a consequence of a payment system that discourages prevention and management of care, Americans spent almost $29 billion on 4.4 million hospital stays for potentially preventable conditions in 2004, according to a study sponsored by the federal Agency for Healthcare Research and Quality.
What you can do. Take lifestyle changes seriously, especially if you are at risk for heart disease, stroke, diabetes, or cancer. If you have a chronic disease, work with your doctor to devise a plan to manage it.
Health-care costs are ballooning partly because the system is geared toward providing expensive interventions and remedies after health problems develop. "We don't have a system in this country that rewards sitting down with people and educating them as to why it's important for them to change behavior so that they're more healthy," said George Isham, M.D., medical director and chief health officer for HealthPartners, a nonprofit Minnesota HMO whose primary-care doctors were rated better than average in our Ratings of HMOs.
