Doctors Slow to Adopt Tech Tools That Might Save Patients Money on Drugs
npr.org
npr.org
To be clear, I am acutely aware of just how hard it is to get this sort of thing working (MS in health Econ, phd in biomedical and clinical informatics). Just keeping track of all the formularies seems like a pain just to to begin with!
Where I live, there are two competing networks of doctors now that have basically absorbed thousands of doctors in the last 4 years with their signs literally plastered everywhere now.
Yay because arguably it's the only way doctor offices are going to keep up with ever changing tech. Nay because Americans are going to get fucked in the ass even more by uncontrollable healthcare when the doctors networks become cartels.
In either case, the major role of healthcare consolidation has been to keep up with insurance consolidation, which is to keep up with hospital consolidation, and so on [4].
[1]. https://www.hhs.gov/hipaa/for-professionals/special-topics/h...
[2]. https://www.healthaffairs.org/do/10.1377/hblog20190304.99820...
[3]. https://cio.ucop.edu/making-epic-history-ucsd-and-uci-health...
[4]. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.6....
Keeping up with the tech is not the problem, it's keeping up with the ever changing regulations, many of which do relate to EHR. You basically need dedicated staff to handle the bureaucratic processes, which is only affordable for large organizations.
The caveaat that it would only show Blink's price, which was actually not the insurance price (they are not insurance but instead a PBM pass thru, cheaper-than-usual cash price). The data point was not comprehensive, of course... But my point still stands
The system requires numerous feedback loops and clinical overview (ours is called NICE - National Institute of Clinical Excellence).
Is it perfect, no, few human things are.
Is it massively preferable to the average healthcare situation for Americans - hell yes it is.
I pay for my prescriptions which is £9 per drug per month (whatever the cost to the NHS of that drug is), I take 3 drugs so that should be £27 per month except they considered that case and I buy a NHS Pre-Payment Card which costs me about £10 a month and covers me for any number of medications. [1]
So for £10 a month I get the routine medications I need to make my life not just bearable but enjoyable which allows me to work.
So if costs controls in government are your concern the elect better people with better systems.
Lest anyone think I'm all sunshine and roses on the NHS, it requires drastic reformation (and they really really need to get rid of their 'internal market' way of running) but the idea is as sound now as it was in 51 years ago (almost to the day, it was founded July 5th 1948).
Your average American has employer-paid health insurance, which covers most of their costs. According to the OECD, average out-of-pocket healthcare expenditure in the U.S. is $1,370, versus $629 in the U.K. https://data.oecd.org/healthres/health-spending.htm. Keep in mind that median household disposable (post-tax) income in the U.S. is $45,000, versus $29,000 in the U.K.
One case is the obvious cost of having a child in America, even with insurance some people pay thousands of dollars.
The difference in median disposable income between the U.S. and the U.K. is stunning: almost $17,000. Even after you factor in things like student loan debt (averaging $220/month for the minority of people who have student loans at all) and out-of-pocket healthcare expenses and premiums (a few thousand a year on average, versus maybe a thousand or so in other OECD countries), the median American household is coming out way ahead.
> Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall. [2]
United Kingdom suicide rate per 100,000 7.5, United States 13.8 [3]
United States Murder Rate per 100,000 5.35, United Kingdom 1.2 [4]
More to life than money I guess, also your $17,000 is accounting for income distribution, at first glance that looks good but while our income distribution is pretty bad, the US is positively Dickensian.
No jingoism intended here, we get a lot wrong and other countries straight up kick our arse (Spain's infant mortality rate is half ours at 2.0 for example amongst major European countries) but that just means we should be looking to improve.
[1] https://data.oecd.org/healthstat/infant-mortality-rates.htm
[2] https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most...
[3] https://data.oecd.org/healthstat/suicide-rates.htm#indicator...
[4] https://en.wikipedia.org/wiki/List_of_countries_by_intention...
As to income distribution: that’s the OECD’s estimate of the median household. So it’s not being skewed up by super-rich households.
As to bankruptcies, less than 0.5% of households file for bankruptcy in a given year.
As to homicide or suicide rate: again, that affects a tiny minority. Meanwhile, the much higher income affects 60-70% of the whole population.
The U.K. is a society where you’ve lowered the median to lift up the floor. That’s one way to do it. And I don’t even disagree with you that the US should do more in that regard. But if you support an expanded welfare state (and I do), it’s dishonest to sell that policy to people by pretending that the average person is going to be better off. Unless they place a very high value on security (avoiding low probability outcomes like medical bankruptcy) over material comfort, they’re going to be worse off.
Is inequality not a problem, because on average we all have the same opportunities?
More in the UK get free prescriptions than don't. Even with the most involved care I can't find a way to make it that expensive. So maybe they're including people voluntarily paying some treatment not available on the NHS like homeopathy or unproven experimental treatments, or private insurance generally. Maybe they count dentistry as healthcare.
Prescription charges for some, hospital parking, drinks machine... Unless you include something else it doesn't add up.
I have two serious conditions and it costs me a quarter of that.
Arguably the NHS model is the only way to get government healthcare to work at all in the US. You would need to gut both private insurance and private hospitals, whose continued political clout would naturally drive up costs if they were allowed to continue existing in their current form.
(In fact, there is already an “NHS-like” example in the US: VA Hospitals for veterans. I’m not sure what we can learn from them, however, as lessons from treating the veteran population may not be able to be extrapolated to the other 300+ million of us.)
You can’t sue the government unless they decide to allow it, so at least we’ll see the end of malpractice suits. /sarc
VA is not what you want for USA
However, i should point out that one reason the NHS drug benefit (and that of mostly every country) is not completely broken and obsolete is because USA effectively subsidizes research for drugs that the rest of the world then copies
You'd be hard-pressed to find many docs (myself included) who are champing at the bit to adopt an informational resource with knowledge gaps.
Even if this product could aggregate data from all the PBMs, that doesn't mean the drug will be in stock at a patient's local pharmacy.
Furthermore, there are many commonly prescribed drugs that are cheaper to buy outright using a discount program (not insurance). Also, there are manufacturer-to-patient rebates offered for some brand name drugs without a generic.
In short, there's a lot more information that doctors already factor into their decision-making process. This tool is not compelling enough to bring into the mix.
In other words, if a doctor prescribes me a $1000 medicine instead of a $500 one, and a visit to said doctor costs $500, I might not visit him a second time because I've already paid $1000 for the medicine and I don't have enough money for my health anymore. Not visiting your doctor when you need it (for whatever reasons) is bad for the patient.
But even if doctors who needed more patient bookings could attract those bookings by saving patients money then logic would follow that doctors who have room in their schedule would consistently use the app from the article. Yet most doctors aren’t using it at all.
So even if your premise is correct I think you’re greatly overestimating the surplus supply of doctors appointments and underestimating how steep/inelastic the demand curve is for healthcare.
Mostly unrelated, is saying “surplus supply” redundant? I can’t decide.
If the insurance is available, and so good, then they should handle the payment stuff. A doctor should be learning about treatment, research and patients, not which company has the cheapest drugs this month.
Doctors prescribe specific drugs. They don't prescribe "whatever SLGT-2 inhibitor your insurance plan covers". They also don't prescribe "whatever your approved first-line therapy for rheumatoid arthritis is". If doctors prescribe without caring about the cost to their patients, the best case scenario is that those patients come back for another prescription after the pharmacy tells them that their drug will cost $$$$ because insurance is not covering it. The worst case scenario is that the patients don't come back and decide they can't afford to have their condition treated.
[0] Barring patient intolerance to the preferred drug or various other exceptions.
Puff pieces are a dime a dozen.
What's more likely: that the hardest working, highest average IQ professionals are slow to adopt something that would help them save their patient's lives? Or that the writer of the article is biased and exaggerating things?
This is already the case with checklists, which are proven to save lives but resisted by many doctors: https://www.newscientist.com/article/2090554-not-all-surgeon... . In my limited experience with doctors a non-insignificant proportion seem to care more about their own ego than saving lives (the kind of people who would bring up their own IQ in a discussion).
Medical error is apparently the third largest cause of death in the US (https://www.cnbc.com/2018/02/22/medical-errors-third-leading...), and surgical checklists have been shown to reduce error rates by 40%: https://www.theguardian.com/society/2009/jan/14/health. In any other profession it would be completely unacceptable to refuse to use a technique like checklists on the grounds that "I don't make silly mistakes"; imagine if an engineer working on safety-critical equipment said "My code doesn't need any testing because I don't make mistakes".
I have checklists for holiday packing with different sub checklists for beach, ski, etc vacation.
At work there are checklists for code review that I personally find don't help. Why? I didn't make that checklist myself. It's a checklist basically containing every mistake anyone ever made that could have or should have been caught in review.
This leads to a checklist of hundreds of Well-d'uhs, because a lot of people make many silly mistakes.
I have a personal review checklist with the things I often forget. I think checklists only work if they're full of pertinent information, and for many professions I think that depends on the person using the checklist and whether they're motivated to use it or obliged to.
This kind of generalization is normally read as "Typically, doctors [as a profession] are slow to…" rather than "Literally every doctor is slow to…". TFA supports that statement with a metric and some reasons why.
> What's more likely: that the hardest working, highest average IQ professionals are slow to adopt something that would help them save their patient's lives? Or that the writer of the article is biased and exaggerating things?
The former. Most doctors work within systems, and can't just start using new tools they think look neat. Instead, they use approved (often mandated) tools.
Medical professionals need to be slow to adopt alternatives because they are required (and expected) to be highly reliable. Just because there's a particular industry where rebuilding the whole infrastructure every 6 months without fear of any consequence is considered normal or even desirable, that does not mean the rest of the world should or even could operate likr that.
This approach has pros and cons: too slow to adopt surgeon hand-washing, but too fast to adopt Thalidomide. A few thousand years of experience has led us to err on he side of being conservative these days.
Combine this culture with lack of spare time for young doctors, lack of immediate incentives to save patient money, and lack of exposure to IT innovations, and I can totally see them being slow to adopt new tech.
At this point I go into every news article fully expecting it to be an attempt by the author to manipulate me.
And as CT scans are private information, why would you assume it would be Ok to make them available through a public server and send them over the internet?
Encryption. A magical tool to make sure things are not available to anyone just because they are available on the Internet. Email on the other hand is so insecure (and cannot be easily encrypted, because many popular programs/email-providers don't support it) that a server sounds like a far better idea.
edit/expanded: I have seen all variants here. Usually you go to another hospital, so they don't have all your things. If this is planned I have all the things I got with me, so the doctors have to filter, sort and scan them (every hospital has to do this again), but at least they have something to start with.
Often the other hospital also sent something before you arrive if this is a planned cooperation. Maybe these two things together are enough, sometimes they are not. If it's just a report the current hospital can ask for it from the other and they get it faxed. But maybe it's a CT, MRT or whatever scan. These things are big, so they get send per courier, which takes time. Now you have to maybe wait longer for whatever you are there for. In extreme cases it can go down to "I here have what you want and you need it now, so you ask me questions over the phone and I answer you" which is asking for all kinds of problems. All in all the current process is slow, involves repeating work and leads to not everyone having the whole picture.
The need to make sure all these private data are safe is very real, but though is the need to get better than this system, cause it doesn't work well and we know that something better is possible here.