Given these extraordinary facts, it is unsettling that instead of mobilizing to enact the patient safety measures recommended by the IOM, doctors and insurers and their political allies have mounted a massive misinformation campaign here in Florida and elsewhere to change the subject. Their claims defy all manner of logic and common sense. They would have you believe that Floridas medical malpractice insurance rates are climbing 20 to 30 percent a year because of a crisis in the legal system. The fact is that new malpractice claims and malpractice awards didnt all of the sudden start jumping 20-30 percent a year over the last two years when the big jump in rates started to occur.
|โดย: สกปรกที่สุด [17 ม.ค. 49 18:15] ( IP A:184.108.40.206 X: )|
|โดย: Fact [17 ม.ค. 49 20:10] ( IP A:220.127.116.11 X: )|
The Medical Money Pit
A dozen years ago, everyone was talking about a health care crisis. But then the issue faded from view: a few years of good data led many people to conclude that H.M.O.'s and other innovations had ended the historic trend of rising medical costs.
But the pause in the growth of health care costs in the 1990's proved temporary. Medical costs are once again rising rapidly, and our health care system is once again in crisis. So now is a good time to ask why other advanced countries manage to spend so much less than we do, while getting better results.
Before I get to the numbers, let me deal with the usual problem one encounters when trying to draw lessons from foreign experience: somebody is sure to bring up the supposed horrors of Britain's government-run system, which historically had long waiting lists for elective surgery.
In fact, Britain's system isn't as bad as its reputation - especially for lower-paid workers, whose counterparts in the United States often have no health insurance at all. And the waiting lists have gotten shorter.
But in any case, Britain isn't the country we want to look at, because its health care system is run on the cheap, with total spending per person only 40 percent as high as ours.
The countries that have something to teach us are the nations that don't pinch pennies to the same extent - like France, Germany or Canada - but still spend far less than we do. (Yes, Canada also has waiting lists, but they're much shorter than Britain's - and Canadians overwhelmingly prefer their system to ours. France and Germany don't have a waiting list problem.)
Let me rattle off some numbers.
In 2002, the latest year for which comparable data are available, the United States spent $5,267 on health care for each man, woman and child in the population. Of this, $2,364, or 45 percent, was government spending, mainly on Medicare and Medicaid. Canada spent $2,931 per person, of which $2,048 came from the government. France spent $2,736 per person, of which $2,080 was government spending.
Amazing, isn't it? U.S. health care is so expensive that our government spends more on health care than the governments of other advanced countries, even though the private sector pays a far higher share of the bills than anywhere else.
What do we get for all that money? Not much.
Most Americans probably don't know that we have substantially lower life-expectancy and higher infant-mortality figures than other advanced countries. It would be wrong to jump to the conclusion that this poor performance is entirely the result of a defective health care system; social factors, notably America's high poverty rate, surely play a role. Still, it seems puzzling that we spend so much, with so little return.
A 2003 study published in Health Affairs (one of whose authors is my Princeton colleague Uwe Reinhardt) tried to resolve that puzzle by comparing a number of measures of health services across the advanced world. What the authors found was that the United States scores high on high-tech services - we have lots of M.R.I.'s - but on more prosaic measures, like the number of doctors' visits and number of days spent in hospitals, America is only average, or even below average. There's also direct evidence that identical procedures cost far more in the U.S. than in other advanced countries.
The authors concluded that Americans spend far more on health care than their counterparts abroad - but they don't actually receive more care. The title of their article? "It's the Prices, Stupid."
Why is the price of U.S. health care so high? One answer is doctors' salaries: although average wages in France and the United States are similar, American doctors are paid much more than their French counterparts. Another answer is that America's health care system drives a poor bargain with the pharmaceutical industry.
Above all, a large part of America's health care spending goes into paperwork. A 2003 study in The New England Journal of Medicine estimated that administrative costs took 31 cents out of every dollar the United States spent on health care, compared with only 17 cents in Canada.
In my next column in this series, I'll explain why the most privatized health care system in the advanced world is also the most bloated and bureaucratic. https://www.nytimes.com/2005/04/15/o...=print&position=
|โดย: อันนี้ก็ได้ [17 ม.ค. 49 21:55] ( IP A:18.104.22.168 X: )|
The strong historical influence of provider interests on the structure of public and private health insurance in the United States created lucrative reimbursement formulas for hospitals and physicians. As a result, hospitals and physicians in the United States were able to obtain considerably higher prices for their services than did providers of similar services in other nations (10, 11). Moreover, even though the quantities of physician visits and hospital days per capita have been lower in the United States than the average developed nation (11), the use of expensive technologieswhich is also influenced by provider market poweris higher in the United States (10, 11). Thus, according to this perspective on health care costs, the gap between health expenditures in the United States and those in other nations is explained by the higher prices of all services and the greater quantities of high-technology services in the United States. Measures to control both the prices and quantities of services have been only partially and temporarily effective.
|โดย: โกหกไม่เป็น อคติก็ไม่มี [17 ม.ค. 49 21:59] ( IP A:22.214.171.124 X: )|
Integrating the 7 Perspectives on Health Care Costs
The first article of this series (1) posed 5 questions concerning health care expenditures: 1) Are high and rising expenditures a serious problem? 2) Why are expenditures higher in the United States than in other countries? 3) Why are expenditures growing so fast? 4) What strategies are available to slow their rate of growth? and 5) Do strategies exist that enable physicians to reduce costs while improving or protecting quality?
The first article also listed 7 perspectives concerning health care costs: 1) High and rising costs are not such a serious problem. 2) High and rising costs are a problem, but they are created by factors external to the health care system. 3) High and rising costs are caused by the absence of a free market; the remedy is to give patients more responsibility for costs of care and to encourage competition among health insurers and providers. 4) High and rising costs are the result of medical technologies creating innovation in the diagnosis and treatment of illness. 5) High and rising costs are in part the result of excessive costs of administering the health care system. 6) High and rising costs are explained by the absence of strong cost-containment measures. 7) High and rising costs are the result of the market power of health care providers.
Drawing on the discussions of these 7 perspectives, we will address the first 4 questions; the fifth question is the subject of the fourth article in the series.
Are High and Rising Expenditures a Serious Problem?
High and rising health care expenditures may not threaten the vitality of the U.S. economy, but they are a serious concern for groups within the economy: employers, employees, governments, taxpayers, and patients. For individuals and organizations who earn their income by providing or supplying health serviceshospitals, pharmaceutical companies, and physicianshigh costs may be beneficial.
Why Are Expenditures Higher in the United States Than in Other Countries?
Per capita health expenditures are far higher in the United States than in any other nation. The explanation for this fact varies with different historical periods. The gap between health care expenditures in the United States and those of other nations began more than 40 years ago (46) and was associated with hegemonic market power of hospitals and physicians, who were able to garner high prices for their services. While this price gap persists, a more recent development contributing to the widening difference between costs in the United States and those of other nations (47) is the more rapid diffusion of innovative technologies in the United States. The cost of administering the health care system is another reason why the United States is an outlier in its health care expenditures.
Why Are Health Care Expenditures in the United States Growing So Fast?
It is one thing to explain why costs of health care are high in the United States compared with the rest of the world. Understanding the growth of costs within the United States is a different matter. Provider prices and administrative costs do not explain why costs increase so fast. An aging population has only a small influence on cost growth. Two interrelated factors appear to explain much of the rapid rise in health care expenditures: the spread of innovative technologies and a health system in which providers dominate the market. When payers curbed prices and quantities of medical services in the early 1990s, hospitals consolidated into systems that could command higher prices and fewer restrictions on quantities of services. Because most facilities for new technologies were located at hospitals, hospital market power enabled these technologies to proliferate. These technologies, if used appropriately for patients who would benefit the most, promise improved quality of care, but the increasing quantities of these high-priced services fuel health expenditure growth.
What Strategies Are Available To Control the Growth of Health Expenditures?
Making patients responsible for the costs of their care can reduce expenditures for patients with low levels of expenditures; however, there is no convincing evidence that patient cost-sharing reduces expenditures for the 10% of the population that incurs 70% of health care costs. During the early 1990s, competition showed some promise of reducing costs for purchasers seeking health insurance and for health insurers contracting with hospitals. However, consolidation of health plans and hospitals thwarted efforts to develop markets in which competition could occur. The absence of a competitive free market for health care services reflects the market power of providers.
Because technologic innovation in the environment of strong provider market power is associated with increasing expenditures, cost-containment efforts directed at these 2 factors may hold promise for slowing health expenditure growth. An example would be technology assessment programs that set standards of appropriate care, which are in turn linked to a system of provider payment that reimburses diagnostic testing and medical procedures only if they have been used appropriately.
Global budgeting and strict expenditures capsa strategy to limit the total amount of money that flows into the health care economyare potentially the strongest cost-control measures. Whether such a strategy can (or should) withstand the imperative for technologic innovation is doubtful. Although most medical advances diffuse more rapidly in the United States than in nations with expenditure limits, per capita use of new technologies in other nations is catching up to U.S. rates.
High and rising health care costs require a multifactorial explanation. How should physicians, who are major participants in the rising cost drama, think about this topic? Is expenditure growth a reasonable price to pay for improved quality? Or will costs rise so high that employers and individuals become unable to afford health care, thereby reducing access andbecause quality requires accessalso reducing quality? The final article of this series examines some cost-control strategies related to medical practice that may reduce costs while protecting or improving quality.
|โดย: แถมอีกหน่อย [17 ม.ค. 49 22:02] ( IP A:126.96.36.199 X: )|
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ประเทศไทยของเราแม้ว่าจะไม่มีความเจริญทางด้านวัตถุเทียบเท่ากับในต่างประเทศ แต่ในฐานะที่เรามีโอกาสได้รู้จักพระพุทธศาสนา ก็หวังว่าเราน่าจะนำมาใช้ ไม่ไปตามก้นเสียทุกเรื่อง ในสังคมมีทั้งแพทย์ที่ดีและไม่ดี และแม้ว่าเขาจะดูไม่ดีแต่บางทีก็มีส่วนดี เช่นเขาอาจเป็นหมอปากหมา แต่เขาก็หวังดีกับผู้ป่วย หรือกลับกันเขาอาจเป็นหมอเทวดาสำหรับผู้ป่วยแต่จริง ๆ เขาหลอกลวง เขาวางยาให้เสพติด
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