We have a real paradox in American healthcare. On the one hand we have exceptionally well educated and well trained providers who are committed to our care. We are the envy of the world for our biomedical research prowess, funded largely by the National Institutes of Health and conducted across the county in universities and medical schools. The pharmaceutical industry continuously brings forth life saving and disease altering medications. The medical device industry is incredibly innovative… Continue
Added by Stephen C Schimpff on September 18, 2012 at 5:05pm —
For a parent of a child with cystic fibrosis, a new drug that could eradicate symptoms could be a God send. The same could be said of a parent of child with Angelman’s syndrome. For a patient with lung cancer, a drug that is more than marginally effective would be wonderful. And for a person with early Alzheimer’s or their loved ones, a drug that might actually reverse the disease would be incredible.
New drugs are approved by the Food and Drug Administration (FDA) regularly.… Continue
Added by Stephen C Schimpff on March 18, 2012 at 5:22pm —
It is currently popular for government officials to single out the insurance companies for the rising cost of healthcare. Not that the insurers are without fault but the real reasons for cost increases are rarely addressed and therefore not appreciated. We are a country with an aging population (“old parts wear out”) and of many adverse behaviors (e.g., overweight, sedentary lifestyle, stress and 20% still smoke.) Combined, these are driving a rapid increase in chronic diseases such as… Continue
Added by Stephen C Schimpff on March 27, 2011 at 8:45am —
During the healthcare reform debate there was the unfortunate reference to “death panels.” No such thing was ever in the proposals but it meant that an important part of medical care was set aside as too “toxic” to discuss. But end of life counseling is very important. Indeed it is good to have realistic discussions at the beginning of a serious illness; indeed it is only fair to the patient and the patient’s family.
Palliative care (I don’t like the term; it seems to… Continue
Added by Stephen C Schimpff on February 21, 2011 at 4:22pm —
Age-related macular degeneration (AMD) is the leading cause of blindness in the United States. More than 1 million Americans have neovascular or “wet” AMD and a slightly lower number have “dry” AMD which often progresses to the more severe “wet” form. Since this is a disease of aging, we can expect many more cases as the population expands in the coming years.
Neovascular AMD appears to be related, at lease in part, to excess production of vascular endothelial growth factor… Continue
Added by Stephen C Schimpff on December 8, 2010 at 2:25pm —
I have written frequently about the importance of chronic illnesses. Most of us are just not aware that their incidence is rising - and rapidly. We tend to think instead about acute illnesses and injury but chronic illnesses are now not only common but last a lifetime once developed and are inherently expensive to treat. On top of that there are enormous losses in quality of life, personal productivity and economic impact on the individual and society.
The Milken Institute quantified some… Continue
Added by Stephen C Schimpff on October 19, 2010 at 2:57pm —
Whether we have commercial insurance through our employer or Medicare, the incentives are poorly aligned to lower costs and improve quality. In fact, they actually encourage greater and greater expenditures. In most instances, our insurance covers everything from prevention to basic routine care to complex care of serious illness. Coverage may not be all that good for some things like preventive care and our primary care physician feels underpaid for routine visits but nevertheless we basically… Continue
Added by Stephen C Schimpff on July 1, 2010 at 8:47am —
Today America does not have a true healthcare system that focuses on wellness and disease prevention. Rather it focuses on disease diagnosis and treatment paid for on a unit basis. Each visit, each procedure, each test, each drug, each hospitalization is charged for. The result is more and more units of care are given rather than a focus on how to give good preventive care and how to coordinate the care of those with complex chronic illnesses. As long as we have a disease industry – driven by… Continue
Added by Stephen C Schimpff on June 24, 2010 at 5:36pm —
The following was an invited post on the Harvard Business Review at http://blogs.hbr.org/cs/2010/04/is_technology_a_cost_driver_or.html
Pharmaceutical, biotechnology, and medical-device and equipment companies have been extremely effective at producing innovations that have created major benefits for medical care. But the cost of new patented drugs and devices (pacemakers, defibrillators, stents,… Continue
Added by Stephen C Schimpff on April 20, 2010 at 3:47pm —
The following was posted by me at Harvard Business Review yesterday. http://blogs.hbr.org/cs/2010/04/teamwork_can_help_avert_the_pe.html
Most health care money in the United States goes largely for the care of people with complex chronic illnesses such as diabetes, heart failure, cancer, lung disease, and the like. We will soon see many more individuals with these illnesses because of two factors: the… Continue
Added by Stephen C Schimpff on April 13, 2010 at 11:08am —
Two major reasons for cost escalation are lack of good care coordination of those with complex chronic illnesses and inadequate attention to prevention and screening. PCPs are key to both of these but they have too little time per patient and are not paid for either activity. About 5% of all healthcare expenditures go to PCPs but they can have a major impact on the other 95%, especially with good care coordination of chronic illness and with a focus on prevention.
To fix this, PCPs… Continue
Added by Stephen C Schimpff on January 14, 2010 at 5:19pm —
During the presidential debates, Tom Brokow asked “is healthcare a right, a privilege or a responsibility?” The candidates did not answer the question but now would be a good time for Congress and the Obama Administration to balance the rights being offered as part of reform with corresponding responsibilities.
We are the only developed country that does not assure all of its citizens basic medical care insurance access – shame on us. We spend more per capita for medical care than any… Continue
Added by Stephen C Schimpff on January 6, 2010 at 10:15am —
It makes good sense to have all of us more involved in our healthcare decision-making and with that its payments. But individuals purchase healthcare in a manner unlike any other purchase. Patients or their loved ones do not “shop” for the best price the way they shop for a new washing machine. They shop for the best [as they understand it] physician, hospital, etc. Mostly they accept the advice of their personal physician as to drugs, surgery or rehab. That said it makes sense to have high… Continue
Added by Stephen C Schimpff on January 4, 2010 at 10:24am —
Drug and technology companies, doctors, hospitals, malpractice lawyers and third-party payers/insurers deserve some approbation and bear some responsibility at the margin, but these are not the major reasons why costs are rising. But it seems that politicians, the media and so many others seem to believe what’s convenient rather than what is accurate.
The real culprits are: 1) the poor coordination of care of those with chronic illness resulting in excess visits to specialists,… Continue
Added by Stephen C Schimpff on December 29, 2009 at 11:05am —
Unfortunately that is not the case; indeed it will create substantial added expenditures. Today we spend about $7500 per capita for medical care each year. That is built into our insurance whether it is commercial or Medicare along with co-pays and deductibles. In my view it is unfortunate that Congress has not done much to address the high and rising costs of medical care in the reform bills.
America is the only country in the developed world that does not have some system to ensure… Continue
Added by Stephen C Schimpff on December 23, 2009 at 11:59am —
This is also not at all likely except for those who do not now have medical care insurance. For the rest of us, medical care delivery will change but it will change not because of reform but because of some fundamental societal and demographic reasons along with a marked change in the types, severity and chronicity of illnesses that is occurring right now. The combination of an aging population and our non-healthy lifestyles (obesity, poor nutrition, lack of exercise, stress and smoking) are… Continue
Added by Stephen C Schimpff on December 21, 2009 at 2:12pm —
A very important reason for medical care cost escalation has to do with our own personal behaviors. We are a country of people who are overweight --one-third are overweight and one-third or more are frankly obese --, under-exercised, poorly fed from a nutritional perspective and highly stressed. And it gets worse each year. Even children have progressively declining physical activity from about three hours per day at age nine to less than an hour by age fifteen. And this will correlate to… Continue
Added by Stephen C Schimpff on July 31, 2009 at 9:08am —
The switch from acute to complex chronic diseases and the wide variation in care patterns are closely related. It is the complex chronic diseases that need the most attention and hence are most expensive to treat. But as a country we have long had the tradition of the independent, autonomous practioneer in the community taking care of us. This was fine for acute illnesses. The physician could either treat you him or herself or else would refer you to a particular specialist for needed care.… Continue
Added by Stephen C Schimpff on July 20, 2009 at 10:00am —
Recently Conrad Cyburn posted a note about the approach of Kaiser to keep costs down while quality high. They do a good job of avoiding the variations in care that exist across the country and which are part of thereason that caare is both expensive and not as good as it could or should be. There are wide variations in care expenditures from geographic region to region. One might assume that those regions with higher expenditures reap better health but that is simply not the case.… Continue
Added by Stephen C Schimpff on July 16, 2009 at 10:13am —
I appreciate the comments to my earlier post on the state of America's health care delivery system. We have incredible medical advances, of the type often referred to on MedTecIQ, but if they cannot be dellivered to the right people at the right time, then they are not being fully utilized to best advantage. One pressing need is to recognize the marked shift in disease prevalence from acute illness to chronic illnesses that has occured over the years; it is a real… Continue
Added by Stephen C Schimpff on June 29, 2009 at 2:14pm —