I’m about to embark on new adventure in problem-solving: how to reduce US healthcare spending, 2018 edition.   For background, check out last year’s adventure in exploring the same problem:

A Market-Based Approach to Healthcare?

Healthcare is unlike other consumables. High prices can motivate people to be cost-conscious, planful, and spend responsibly. That is a good thing when it comes to purchasing cars or televisions. Not so when you delay seeing the doctor about that pesky stomach ache.

The High Cost of Healthcare: How to Control Physicians, Part III

Slowly but surely the US is catching on to the advantages of using nurse practitioners as independent primary care gatekeepers, despite the AMA’s ongoing opposition. A big factor in the gradual acceptance of this expanded role for nurse practitioners is the shortage of GPs, which has left millions of Americans without access to primary care providers.

The High Cost of Healthcare: How to Control Physicians, Part II

In the US, the incentives are aligned to test more, treat more, and charge more. Simply shifting to a mandatory gatekeeper system would go a long way to reining in US healthcare costs. Gatekeepers keep down unnecessary procedures. Gatekeepers also earn a lot less than specialists.

The High Cost of Healthcare: How to Control Physicians, Part I

Physicians make way more in the US than other developed countries - like about twice as much. What do other countries do to contain physician fees? Many things, including:

  • Fees are regulated.
  • Healthcare budgets are determined in advance.
  • Doctors are mostly on salary and not paid on a fee-per-service basis
  • GP gatekeepers control referrals to specialists.
  • Defensive medicine is minimized through no fault malpractice systems.
  • Defensive medicine is minimized by government-imposed guidelines on diagnostic procedures and treatment.
  • Other medical professionals, such as nurse practitioners, assume primary care responsibilities. 

Healthcare: How the Japanese Do It

Japan's healthcare system is universal, accessible, and relatively cheap compared to that of the US (11.2% versus 16.9% of GDP). It is a multi-payer system that manages to avoid excessive rationing and wait times. How do they do it? For one thing, the Japanese government controls the costs of services. As a result, Japanese healthcare professionals, including physicians and nurses, are paid way less than their American counterparts.

The Three Pillars of Health Care Reform: Coverage, Cost, and Quality

There's no way you can go from making it easier to buy health insurance, or to incentivize buying health insurance, and get to universal coverage. Some people just can't or won't buy insurance.  The US would still have millions uninsured if we had a completely voluntary system.

Reducing the Cost of US Healthcare, Part I

The US has the highest paid doctors in the world. Even the AMA cannot deny this fact.  One reason is that, compared to other countries, Americans received more care from specialists. Specialists are both expensive and not very good at managing chronic conditions, which are expensive to treat when they get out of control.  We need gatekeepers to specialized care – just like in Denmark.  

Healthcare Costs and What to Do about Them/Part IV

The US does more medical tests and procedures than other developed countries. These tests and procedures are performed by highly paid healthcare professionals. Often the medical devices required in these tests and procedures are expensive. It all adds up.

Healthcare Costs and What to Do about Them/Part III

I’ve been focusing on four areas that seem to account for a big chunk of US healthcare spending: hospital services, salaries, diagnostic tests, and medical interventions. This post will address salaries. In short: US physicians and nurses are paid more in the US than in other developed countries. Usually a lot more.

Healthcare Costs and What to Do about Them/Part II

To figure out why the US spends so much on healthcare, we need to look at where the money goes….It goes mostly to outpatient care, hospitals and nursing homes, which comprise about 75%  of US healthcare spending. These categories of spending amount to almost $6000 per capita, compared to less than $3000 per capita (PPP) in Germany, France, Canada, and Japan.  

Healthcare Costs and What to Do about Them/Part I

US healthcare spending is almost twice that of the other developed countries. Pharmaceuticals and medical goods (e.g., medical supplies and devices) are a relatively small part of that difference. If we knocked off, say, $200 a year in drugs and medical goods, we'd hardly make a dent in overall US healthcare spending – which is approaching a per capita average of $10,000 a year.  

The above blurbs are highly abbreviated summaries. Click on the links for the complete posts. Exploration can be a methodological process.

Next: Reducing costs without sacrificing quality of care. That is the challenge. Take the case of nurse staffing. Sounds dull? It’s not!