With all the noise going on in the U.S. health system crisis, many are likely to focus problems, and even fewer know how to find the cause of the problems. I am appalled by the tone of the discussion (although I understand the fear people have ---) and a loss that suggests someone who is qualified enough to know better how to best simply to our health care system because they met him, when people who have spent their entire careers studying (and I do not mean the politicians) are not sure what for themselves.
Albert Einstein had a reputation, have said that if it is 1 hour was to save the world he had 55 minutes spent defining the problem and only 5 minutes to solve it. Our health system is much more complex than most people admit that the solutions or recognize, and if we focus most of our efforts on the definition of problems and in-depth understanding of its causes, are all changes we degrade easily expected, since they which are best.
Although I worked in the U.S. healthcare system as a doctor since 1992 and have seven years experience as CEO of PHC, I do not consider myself qualified to properly assess the viability of most proposals I've heard for improving our health care system. But I think I can at least bring into the discussion by describing some of his problems, under reasonable assumptions on the causes, and emphasizing some general principles that apply to try should be to solve them.
The problem of cost
No one disputes that has the cost of healthcare in the United States have increased dramatically. According to the Centers for Medicare and Medicaid Services (CMS), health care spending is expected to be $ 8160 per person per year to achieve by the end of 2009 compared to $ 356 per person per year, it was in 1970. This increase occurred at about 2.4% faster than GDP growth over the same period. Although GDP varies from year to year and is an imperfect way to increased health care costs compared to other expenses from one year to judge the other, one can still conclude from these data that in the past 40 years, the percentage of our national income (private, business and government), we have on the health spent nursing increased.
Despite what many suspect, this may or may not be bad. Everything depends on two things: why health care spending had increased as compared to our GDP, and the value for every dollar we spend have received.
Why healthcare is so expensive?
It is a difficult question to answer, as many believe. The rising cost of health care (average 8.1% per annum calculated from 1970 to 2009, from data above) crossed to the rise in inflation (4.4% on average during the same period), so we do not write the rising cost of inflation only. Health expenditures are known to be closely linked to the GDP of a country (the wealthiest nation, the more there for the health care system) associated, but also the United States remains an outlier (Figure 3).
Is it because of health issues for people over 75 (five times what we spend for people aged 25 to 34 years of age)? In a word, no. Studies show that this demographic trend explains only a small percentage of growth in health spending.
If it is because of the monstrous profits of the health insurance rack? Probably not. It is certainly difficult to know with certainty that all insurance companies traded on the stock market and therefore have to check balances for the public. But Aetna, one of the listed health insurers in North America, reported income in the second quarter of 2009 to $ 346.7 million, which, if made of projected an annual profit forecast by about $ 1.3 billion in the roughly 19 million people they insure. If we assume, their profit margin on average in their industry (even if false, it is unlikely orders of magnitude different from the average), the total profit of all companies in the private health insurance in America, the 202 million people (point marked second item) in 2007, would come to around 13 billion € per year. The total expenditure on health care in 2007 were $ 2.2 trillion (see Table 1, page 3), resulting in a profit of private health care to about 0.6% of total health care costs (although this analysis, mixed data from different years, it may be possible that the numbers are not likely any other size).
Is it because of fraud in health care? The estimates of losses due to fraud range as high as 10% of all health spending, but it is difficult to find accurate data on up to the back. Although a certain amount of fraud goes undetected, almost certainly, perhaps the best way to estimate how much money is seen to lose fraud, how the government collects in fact. In 2006 it was $ 2.2 billion, only 0.1% of the $ 2.1 trillion (see Table 1, page 3) in the total expenditure on health care this year.
Is it because of the cost of drugs? In 2006, total spending on prescription drugs, over $ 216 billion (see Table 2, page 4) was. Although this amounted to 10% of the $ 2.1 trillion (see Table 1, page 3) of the total expenditure on health care this year and should be considered significant, it remains only a small percentage of total health care costs.
Is it for administrative costs? In 1999, total administrative costs at $ 294 billion, a full 25% of the $ 1.2 trillion (Table 1) estimated the total expenditure on health care this year. There was a significant percentage in 1999 and it is hard to imagine that it was since a significant degree.
Ultimately, however, which probably contributed to how much to increased health care costs in the U.S. are two things:
1st Technological innovation.
2nd Overuse of resources for health care for patients and healthcare providers themselves.
Technological innovation. The data show the rising cost of health care are is primarily on technological innovation to get surprisingly heavy, but estimates account for the contribution to the increase in medical costs on the technological innovation of 40% to 65% (Table 2, page 8). Although we prefer no empirical evidence to show some examples of the principle. Heart attacks are used to treat with aspirin and prayer. Now they are treated with drugs to the shock, pulmonary edema, and arrhythmias as well as thrombolytic therapy, cardiac catheterization with angioplasty and stent implantation or coronary bypass control. You do not need an economist to understand the scenario that ends up more expensive. We can learn to perform these procedures cost in time (the same way as we figure out how computers have reasonably thought), but since the cost is reduced per procedure, with the total amount of each procedure, because the number of cases rises performed spent. Laparoscopic cholecystectomy is 25% below the price of an open cholecystectomy, but the prices of the two increased by 60%. Technological progress is becoming more widely available, they are used more frequently, and one thing that we are very aware, the United States makes the technology available.
Overuse of resources for health care for patients and healthcare providers themselves. We can simply define overfishing as the unnecessary use of healthcare resources. What is not so easy to recognize it. Each year from October to February, the majority of patients who come to the Urgent Care Clinic in my hospital, I think are not so unnecessary. What do they do? Colds. I can support, the certainty that nothing is really wrong, and tips to offer over-the-counter remedies --- but none of these things will make them better more quickly (though I am often able to reduce their level of concern) . In addition, patients have to believe, is to get the key to a correct diagnosis, the collection of history and careful physical examination rather than test the technology-based (not that it is not important - just believe less than the majority of patients - ). How much is overuse of the patient-focused health care system is difficult to define, particularly because we anecdotal evidence above.
In addition, doctors often disagree among themselves about what the consumption of unnecessary health care. In his excellent article, "The Riddle of the costs," Atul argues Gawande, that regional differences in the over-exploitation of resources in health care by the best doctors in the regional differences in Medicare spending per person account. It goes on to say that if doctors could be encouraged overuse curb the high cost areas of the country, it would save enough money to keep Medicare solvent for 50 years.
Albert Einstein had a reputation, have said that if it is 1 hour was to save the world he had 55 minutes spent defining the problem and only 5 minutes to solve it. Our health system is much more complex than most people admit that the solutions or recognize, and if we focus most of our efforts on the definition of problems and in-depth understanding of its causes, are all changes we degrade easily expected, since they which are best.
Although I worked in the U.S. healthcare system as a doctor since 1992 and have seven years experience as CEO of PHC, I do not consider myself qualified to properly assess the viability of most proposals I've heard for improving our health care system. But I think I can at least bring into the discussion by describing some of his problems, under reasonable assumptions on the causes, and emphasizing some general principles that apply to try should be to solve them.
The problem of cost
No one disputes that has the cost of healthcare in the United States have increased dramatically. According to the Centers for Medicare and Medicaid Services (CMS), health care spending is expected to be $ 8160 per person per year to achieve by the end of 2009 compared to $ 356 per person per year, it was in 1970. This increase occurred at about 2.4% faster than GDP growth over the same period. Although GDP varies from year to year and is an imperfect way to increased health care costs compared to other expenses from one year to judge the other, one can still conclude from these data that in the past 40 years, the percentage of our national income (private, business and government), we have on the health spent nursing increased.
Despite what many suspect, this may or may not be bad. Everything depends on two things: why health care spending had increased as compared to our GDP, and the value for every dollar we spend have received.
Why healthcare is so expensive?
It is a difficult question to answer, as many believe. The rising cost of health care (average 8.1% per annum calculated from 1970 to 2009, from data above) crossed to the rise in inflation (4.4% on average during the same period), so we do not write the rising cost of inflation only. Health expenditures are known to be closely linked to the GDP of a country (the wealthiest nation, the more there for the health care system) associated, but also the United States remains an outlier (Figure 3).
Is it because of health issues for people over 75 (five times what we spend for people aged 25 to 34 years of age)? In a word, no. Studies show that this demographic trend explains only a small percentage of growth in health spending.
If it is because of the monstrous profits of the health insurance rack? Probably not. It is certainly difficult to know with certainty that all insurance companies traded on the stock market and therefore have to check balances for the public. But Aetna, one of the listed health insurers in North America, reported income in the second quarter of 2009 to $ 346.7 million, which, if made of projected an annual profit forecast by about $ 1.3 billion in the roughly 19 million people they insure. If we assume, their profit margin on average in their industry (even if false, it is unlikely orders of magnitude different from the average), the total profit of all companies in the private health insurance in America, the 202 million people (point marked second item) in 2007, would come to around 13 billion € per year. The total expenditure on health care in 2007 were $ 2.2 trillion (see Table 1, page 3), resulting in a profit of private health care to about 0.6% of total health care costs (although this analysis, mixed data from different years, it may be possible that the numbers are not likely any other size).
Is it because of fraud in health care? The estimates of losses due to fraud range as high as 10% of all health spending, but it is difficult to find accurate data on up to the back. Although a certain amount of fraud goes undetected, almost certainly, perhaps the best way to estimate how much money is seen to lose fraud, how the government collects in fact. In 2006 it was $ 2.2 billion, only 0.1% of the $ 2.1 trillion (see Table 1, page 3) in the total expenditure on health care this year.
Is it because of the cost of drugs? In 2006, total spending on prescription drugs, over $ 216 billion (see Table 2, page 4) was. Although this amounted to 10% of the $ 2.1 trillion (see Table 1, page 3) of the total expenditure on health care this year and should be considered significant, it remains only a small percentage of total health care costs.
Is it for administrative costs? In 1999, total administrative costs at $ 294 billion, a full 25% of the $ 1.2 trillion (Table 1) estimated the total expenditure on health care this year. There was a significant percentage in 1999 and it is hard to imagine that it was since a significant degree.
Ultimately, however, which probably contributed to how much to increased health care costs in the U.S. are two things:
1st Technological innovation.
2nd Overuse of resources for health care for patients and healthcare providers themselves.
Technological innovation. The data show the rising cost of health care are is primarily on technological innovation to get surprisingly heavy, but estimates account for the contribution to the increase in medical costs on the technological innovation of 40% to 65% (Table 2, page 8). Although we prefer no empirical evidence to show some examples of the principle. Heart attacks are used to treat with aspirin and prayer. Now they are treated with drugs to the shock, pulmonary edema, and arrhythmias as well as thrombolytic therapy, cardiac catheterization with angioplasty and stent implantation or coronary bypass control. You do not need an economist to understand the scenario that ends up more expensive. We can learn to perform these procedures cost in time (the same way as we figure out how computers have reasonably thought), but since the cost is reduced per procedure, with the total amount of each procedure, because the number of cases rises performed spent. Laparoscopic cholecystectomy is 25% below the price of an open cholecystectomy, but the prices of the two increased by 60%. Technological progress is becoming more widely available, they are used more frequently, and one thing that we are very aware, the United States makes the technology available.
Overuse of resources for health care for patients and healthcare providers themselves. We can simply define overfishing as the unnecessary use of healthcare resources. What is not so easy to recognize it. Each year from October to February, the majority of patients who come to the Urgent Care Clinic in my hospital, I think are not so unnecessary. What do they do? Colds. I can support, the certainty that nothing is really wrong, and tips to offer over-the-counter remedies --- but none of these things will make them better more quickly (though I am often able to reduce their level of concern) . In addition, patients have to believe, is to get the key to a correct diagnosis, the collection of history and careful physical examination rather than test the technology-based (not that it is not important - just believe less than the majority of patients - ). How much is overuse of the patient-focused health care system is difficult to define, particularly because we anecdotal evidence above.
In addition, doctors often disagree among themselves about what the consumption of unnecessary health care. In his excellent article, "The Riddle of the costs," Atul argues Gawande, that regional differences in the over-exploitation of resources in health care by the best doctors in the regional differences in Medicare spending per person account. It goes on to say that if doctors could be encouraged overuse curb the high cost areas of the country, it would save enough money to keep Medicare solvent for 50 years.
