A Pound of Cure
Saturday, June 27, 2009 at 05:12 PM EDT
Technology Review, published by MIT, has an interesting article on the use of information technology in health care. As the article points out, the administrationâ€™s economic stimulus package includes $19 billion for health-care IT spending; the aim is to provide an incentive for hospitals and doctors to switch to using electronic medical records. There is some good evidence that such a switch would have benefits, both in reducing administrative costs, and in reducing errors (such as adverse drug interactions). But it isnâ€™t clear that cost is the major obstacle to getting this done:
I suspect that part of this is a kind of cultural aversion among doctors to be seen as motivated by â€œmanagementâ€ concerns like efficiency. But as the author. Andy Kessler, suggests, there may be something more fundamental that is holding things back.
It is an often-cited and depressing fact that the United States spends more money per person on medical care than any other country on Earth, yet gets poorer results in many standard measures of public health (e.g., infant mortality). And it should not come as a surprise to anyone that the cost of health care is an issue of great concern to people generally, as well as being one of the primary factors behind personal bankruptcies.
As Mr. Kessler points out, the way the health care system in the US works, in the majority of cases, is that doctors get paid for treating people who are sick. Other things being equal, doing more tests, treating more patients, and performing more procedures increases the medical practicionerâ€™s income. Now I am emphatically not saying that doctors are all just money-grubbing opportunists, but it is hard to believe that the structure of financial incentives has no impact on medical decisions. In fact, doctors generally do argue that financial incentives have a lot to do with the behavior of insurance companies and malpractice attorneys; I am not convinced that attending medical school makes one completely immune to this kind of consideration.
Furthermore, the current haphazard state of medical record keeping is a significant problem in trying to move toward what has been called â€œevidence-based medicineâ€ â€” that is, a regime where tests and treatments are selected on the basis of solid evidence about what works and what doesnâ€™t:
The really big payoff from better record keeping could be improved health outcomes at lower cost. Better record keeping would also facilitate preventative care, because it would be easier to identify people with risk factors for a disease, or those taking a drug that had a newly-discovered adverse side effect.
In a way, the issue here is trying to move away from the view of the doctor as an individual artisan, and toward a more prevention-focused, team approach to health care.
This article originally appeared on Rich's Random Walks.