If you want top quality healthcare – you can’t get it without someone paying – a lot. The cost goes up every year as more and more procedures and meds are developed. And professional staff is expensive – I have a young ICU nurse client in a major Westchester hospital. Not counting benefits her salary is 140K and no doubt worth every cent. <\/p>\n\n\n\n
Giving patients more skin in the game \u2014 essentially what Republicans say they want to do \u2014 can help, but only a little. High-deductible plans and health savings accounts have limited impact on what the nation spends on health care overall. They\u2019re useful when it comes to medical services where price transparency is possible and clinical stakes are moderate \u2014 regular doctor visits and relatively minor treatments for which costs are foreseeable \u2014 but not for chronic and catastrophic health conditions. How many of us would comparison shop for heart transplants while in cardiac failure, or try to negotiate the price of chemotherapy? Health insurance exists precisely to insulate individuals from these types of risks.<\/a><\/p>\n\n\n\n In complex cases, patients often lack the expertise to evaluate the necessity or quality of proposed treatments and procedures, and they rely heavily on doctor recommendations. That means physician discretion \u2014 as opposed to patient choice \u2014 plays an outsize role in overall spending levels.<\/p>\n\n\n\n Data<\/a> from The Dartmouth Atlas of Health Care has long shown that Medicare spending per beneficiary varies greatly by region, with no correlation between higher spending and more effective care. Patients in high-spending regions simply receive more tests, more procedures and more hospital days.<\/p>\n\n\n\n ********************<\/p>\n\n\n\n This \u201cplace effect\u201d hypothesis was recently tested using data from the Military Health System, which found that the vast majority \u2014 up to 80 percent<\/a> \u2014 of regional spending variation has nothing to do with patient conditions. Studying treatment of American personnel and their families at different locations, researchers assessed that high costs are largely a function not of sicker patients, but of local medical cultures that favor more aggressive care.<\/p>\n\n\n\n The path to greater affordability is clear: alter how physician decisions are made, reducing the amount of unnecessary care physicians call for without harming health outcomes.<\/p>\n\n\n\n **********************<\/p>\n\n\n\n