What’s true in medicine is true in health policy: If you don’t diagnose correctly, you can’t prescribe correctly. If you think the primary care sector needs “redesign,” you will prescribe “medical homes” and “breaking down silos” and other nostrums with labels connoting a change in structure. If, on the other hand, you conclude the proper diagnosis is too few resources, then you recommend more resources.
The “medical home” concept has become counterproductive. It is muddling the debate about how to improve medical care without raising costs, and it is punishing primary care clinics. The paper by Mosquera et al. illustrates both problems.
The health-cost slowdown isn’t just about the economy By David Leonhardt New York Times, December 5, 2014 It’s one of the most important economic questions today: Is the snail-like growth of health costs over the last several years a real trend, or is it merely a temporary part of the Great Recession’s aftermath? The data […]
In a comment I posted on this blog last December, I noted that the Medicare Payment Advisory Commission (MedPAC) refuses to ask a very obvious question about the two Medicare ACO programs authorized by the Affordable Care Act: Do the administrative costs of running an ACO exceed the savings ACOs allegedly achieve for Medicare?
In case you blinked, big data is the newest new thing in establishment health policy.
We need an analysis of errors in health policy and why those errors go uncorrected long after they have been revealed. I would like to suggest that the IOM undertake this task. I suggest they entitle their report, “To Err is Human, and Health Policy is No Exception.”
Evidence-based medicine: A movement in crisis? By Trisha Greenhalgh, Jeremy Howick, and Neal Maskrey for the Evidence-Based Medicine Renaissance Group BMJ, June 13, 2014 It is more than 20 years since the evidence-based medicine working group announced a “new paradigm” for teaching and practicing clinical medicine. Tradition, anecdote, and theoretical reasoning from basic sciences would […]
Successes and failures of pay for performance in the United Kingdom By Martin Roland and Stephen Campbell The New England Journal of Medicine, May 15, 2014 In 2004, the United Kingdom introduced one of the world’s largest pay-for-performance programs, the Quality and Outcomes Framework. … The Quality and Outcomes Framework was originally designed in part […]
Reflections on the VA Scandal KevinMD — Dr. Kevin Pho — the popular physician blogger, suggests that single-payer advocates reevaluate the single-payer idea in light of the scandal now unfolding within the Veterans Health Administration. He calls the scandal “a red flag for those who want a national single-payer system in the United States.” While […]
The critical shortcoming of Porter and Lee’s Value Transformation process is that it reforms our dysfunctional delivery system without first reforming our dysfunctional financing system. There are no examples of any delivery system succeeding in the absence of a functional financing system.
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