Pulse
Briefs
Too Much Medicine?
If writer Shannon Brownlee were to rally health care reformers, she would use as her cry a twist on the catchphrase Bill Clinton used during his first presidential campaign: “It’s the capacity, stupid.”
Brownlee, author of Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, shared her perspective on why health care spending in the United States has gotten out of control with an audience of health policy experts at the University of St. Thomas in November. The culprit, she says, isn’t technology or that some hospitals are treating a disproportionate number of very ill patients: It’s that they’re offering too much treatment. “An uncontrolled amount of health care is being delivered,” she said.
Citing Dartmouth Atlas Project research that followed Medicare patients who had been hospitalized for myocardial infarction, hip fracture, and colon cancer, she noted that differences in regional Medicare spending could be explained by the fact that hospitals offering more services saw increased utilization of those services, whether or not there was evidence to support their use.
The problem, she said, is that patients and physicians often assume that more is better in medicine. “Under this assumption, physicians will use capacity if it’s available. If a patient has trouble breathing and there’s a pulmonary specialist available, the physician is more likely to order a consult. If there are a lot of scanners available, physicians may be more likely to use them because they think it will help them make a diagnosis. It’s supply-push economics.”
Brownlee admitted there is no simple solution to this complex problem but suggested some changes that might make a difference: eliminating fee-for-service payment and moving instead toward salaried group practices, rewarding hospitals that have the best outcomes for the lowest cost and having those facilities teach others how to emulate their practices, instituting a tiered co-pay system in which patients pay less out of pocket for care that has evidence to back it up, and creating a publicly funded “Manhattan project for evidence” that would identify treatments that do and don’t work.—Kim Kiser
Land O' Lawsuits
An article in the December American Bar Association Journal points out that a large number of personal injury lawsuits are being filed in Minnesota by out-of-state plaintiffs against out-of-state defendants, particularly pharmaceutical and medical device companies. The defendant in such cases need only be authorized to do business in Minnesota and have a registered agent in the state who can be served papers. More than 9,000 such suits have been filed, and the pace of filing appears to have quickened in recent years. There were 500 in 2004 and almost 7,000 in 2006.
What’s attracting the plaintiffs? According to the story, Minnesota has longer-than-usual statutes of limitations on personal injury actions—six years for negligence and four for product liability. (Most states have two- to three-year statutes of limitations laws.)
Plaintiffs attorneys quoted in the article said they didn’t think the increasing number of suits would clog Minnesota’s court system because most of the cases become part of multi-district proceedings in which similar cases are lumped together and heard by a single judge. But one defense attorney noted that suits filed in Minnesota that are not resolved in global settlements eventually will make their way back to the state for trial.
Senate Tackles Complexity
Minnesota’s two senators are behind national legislation aimed at simplifying health care for consumers.
In December, Sen. Norm Coleman, R-Minnesota, and Sen. Tom Harkin, D-Iowa, introduced the National Health Literacy Act, the goal of which is to improve consumers’ ability to obtain and understand essential health information. Sen. Amy Klobuchar, D-Minnesota, and Sen. Susan Collins, R-Maine, co-sponsored the bill.
According to a 2004 Institute of Medicine report, 90 million Americans—nearly half of all adults in this country—have difficulty understanding and using health information.
The bill would create a Health Literacy Implementation Center that would gather resources for helping consumers make wise decisions about medical care, establish state-based health literacy centers, and set national goals and strategies for achieving them, according to a press release from Sen. Coleman’s office.
Mayo Takes on Reform
The next president of the United States could be getting ideas for health care reform from a group convened by Mayo Clinic.
Since 2006, staff from the Mayo Clinic Health Policy Center, an initiative led by Mayo Clinic president and CEO Denis Cortese, M.D., have held a series of forums throughout the country, during which they heard from patients, physicians, hospital administrators, insurers, and leaders in business, academia, and government about their frustrations with the health care system.
Out of those meetings came a set of recommendations around universal insurance coverage, coordinated care, value, and payment reform.
Mayo will hold a national symposium in Washington, D.C., next month, during which they hope to create more specific proposals they can share with presidential candidates and others, says Bruce Kelly, director of government relations.
Although a number of physician groups have taken positions on health care reform, Mayo Clinic may well be the only provider organization to do so. According to Kelly, Mayo became involved at the urging of its board of trustees, who were concerned about the aging of the baby boomers and the future of Medicare. “They felt that health care reform was reaching one of those critical mass areas and that Mayo Clinic, as a well-known and well-respected provider, ought to step up and take a role in health policy and reform,” he says.—Kim Kiser
Lack of Understanding
Despite attempts by insurers to explain policies and terms, people still don’t understand key phrases and concepts.
A recent telephone survey of more than 1,000 men and women in the United States sponsored by the parent company of eHealthInsurance, an online insurance broker, found that less than one-quarter (23 percent) said they understood the terminology in their health insurance policy. In addition, only
- 36 percent said they knew what HMO stood for,
- 20 percent knew what a PPO was, and
- 11 percent knew what HSA meant.
Half said they knew what they paid for health insurance each month, and 45 percent said they knew their annual deductible amount.