Is it possible that we can reduce health care cost by providing better care? I heard this story on NPR a few weeks ago and it is fascinating to me because the rising cost of health care is a huge obstacle to my early retirement plan. In fact, health care cost is my #2 obstacle to early retirement, right after #1 – the baby. Health care cost is rising much faster than inflation and sometime I wonder if my investments can keep up with it.
Dr. Jeffrey Brenner in Camden, NJ started looking at ER visits the way police investigated assaults. He asked where the hot spots are and why are they happening. He collected data and found that 1% of patients account for 30% of the healthcare costs in Camden.
In Camden, 1% was about 1,000 people and he thought this might be a manageable number. Dr. Brenner approached his colleagues and asked to take over the care of their most difficult cases. He and his team followed up with these hard cases and took care of them like a primary care provider would. The problem with many of these chronically ill patients was that they were poor and many did not have health insurance, so they went to the ER for medical care. The ER helped in the short term, but inevitable they kept going back to the ER over and over again.
Dr. Brenner and his team were able to lower the overall health care cost by taking better care of these most difficult cases. They followed up with patients to make sure they took their medication, tried to get them to quit smoking, and encouraged them to rejoin their churches and communities. They were basically coaching these patients to take better care of themselves. Their efforts were very successful and many patients improved their long term health and their overall costs were lowered as a result.
Could it be this simple? That we can lower overall health care costs by just coaching chronically ill patients to take better care of themselves? It does make sense. If we can keep these patients healthier, they wouldn’t go to the ER all the time. It’s much cheaper to take heart medication than to go to the ER for heart failure. The story went on to cover another experiment to reduce healthcare cost.
One company increased their co pay for doctor visits and medications in an effort to make employees more cost conscious about going to the doctor. What do you think happened? Their health care costs kept rising. The chronically ill patients’ costs spiked because they hesitated to go see their doctors and some even stopped taking medication. The key to reducing health care cost is to have accessible and affordable health care so everyone can lead healthier and more productive lives.
What can we do as a society?
So what’s my conclusion? We need to eliminate ER services to those people that don’t have health insurance and can’t pay the hospital bill. If we eliminate services to these 1% cases, we could all save 30% on our medical bill. What do you think about this? Make sure they can pay and if they can’t, just send them out the door. 30% off is a huge saving.
OK, I was just trying to be controversial. Today I am in a reasonable good shape and I have insurance, but someday I may fall into the 1% cases. We should provide better long term health care to those 1% patients so they wouldn’t use so many resources. How can we as a society do this? This will clearly benefit everyone, so why is there so much resistance to universal healthcare in the US? These 1% patients are often poor and public healthcare is the only way I can see them getting long term care. Can you think of another options? I know there are quite a few Canadian readers out there, can you comment on your public health care? What are some downside to public health care?
Listen to the rest of this story on NPR. It’s a 30 minutes story, but this is one of the best show recently.
You can get a quote from eHealthInsurance to see how much healthcare would cost.