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| JULY 29 – AUGUST 4, 2009 |
BOISEweekly
OPINION BY GARY KROUTH, M.D. is more opportunity for expense reduction. To address this underlying inequality, Congress needs to account for the impact of utilization. In other words, don’t penalize Idaho for having some of the lowest costs per capita and utilization in the country. ur nation has reached the point to the private sector. Two other areas that must be adwhere all of us, including hospital 3) Underpayment for non-procedural dressed in order to achieve significant and physician organizations, believe work has contributed to the shortage reform are administrative costs and our that significant reform of our health-care of vital primary care providers. tremendous regulatory burden. system is needed. Most appreciate there is The research on utilization is startling. The U.S. Congressional Research no silver bullet solution, but rather a need Areas of the country with more docService estimated administrative costs of for both compromise and change across private insurance and government prothe spectrum, from government and private tors, more hospitals, more free-standing grams in 2004 at about $154 billion. The payers to providers, suppliers, pharmaceu- facilities like imaging centers and limited service, physician-owned surgery centers American Hospital Association estimates tical manufacturers and individuals. another $400 billion is spent by hospitals Numerous reform ideas are being pro- and hospitals, places like Florida and and medical practices in complying with posed. There are aspects of these propos- Texas, have dramatically higher utilizaals with merit: coverage for the uninsured, tion rates and health-care costs per person the thousands of rules and regulations than states like Utah and Idaho. that apply to health-care providers. Simliability reform, physician self-referral What does this mean? Does higher uti- plifying administration and the resulting limitations, payment for outcomes, paylization, or in other words, “more” health- exorbitant cost of compliance and reportment bundling to address the fractured care services, mean “better” health care? ing will reduce health-care costs. payment system, attention to primary Administrative costs include the cost of care services, insurance simplification and Researchers at Dartmouth say “No.” The problem isn’t that lower utilization “defensive medicine.” The threat of lawsuits regulatory reform. Most of these proposmeans lower quality care; it is that higher causes health-care providers to order more als have not yet been fully developed. utilization means more costly care for the tests and procedures than are medically Without further, detailed study of the same quality. necessary. Reforming the way our society components, implementation could well For Idaho, this is critical given that adjudicates injuries from medical malpraclead to unintended consequences. current reform proposals would cut tice will result in cost savings by reducing All of the proposals being considered, reimbursement rates, or the per service this practice of “defensive medicine.” however, do have a common theme: amount paid for care, by the same perEveryone agrees we must stop our reduced payments to providers. This is centage for every area of the country. health-care system from devouring our a tool employed by government (and The net effect for Idaho, a low utilizaeconomic future. To achieve real reform— private) payers for the last 30 years, with tion and low per-capita-cost state (a 2007 the kind that reduces cost and increases history showing that it has exacerbated Kaiser Family Foundation study ranked the quality of care—Congress needs to do many of the current issues we face: Idaho third lowest in the nation), would be better than the current legislation. 1) Per service underpayment has led to dramatically reduced dollars coupled with increased utilization of health services. the same demand for high quality care. Dr. Gary Krouth is the vice president 2) Underpayment from government payCompare this to states like Florida, where and chief medical officer at St. Luke’s ers has caused providers to shift costs utilization and costs are high and thus there Health System.
HEALTH CARE RX A doctor’s take on a broken system
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