Health Is an R&D Problem
Tuesday, June 23, 2009 at 05:31 PM EDT
Our health care system is notoriously inefficient. Spending is too high, while quality is too low. Some patients undergo expensive treatments that provide little or no benefit. At the same time, other patients donâ€™t receive some inexpensive treatments that could materially improve their health.
When I was CFO of a medical software start-up back in 2000, we diagnosed this problem quite simply: actual medical practice falls far short of best practices. Good treatment regimes are often well-known, yet are overlooked by a large fraction of practicing physicians. (The classic example at the time was that doctors were substantially under-prescribing beta blockers, which can help many patients after a heart attack; I would welcome comments about whether thatâ€™s still true.)
The implied treatment for our health care system is also simple: find ways to get patients, physicians, and other providers to adopt best practices. We were focused on information technology as one potential way to do this, but many others have also gotten attention, including:
Done right, each of these approaches could undoubtedly increase the value we get from our health system. Unfortunately, that potential has sometimes been oversold, with advocates arguing that policies to implement such â€œsilver bulletsâ€ would dramatically reduce the cost of health care.
My view is more cautious. We know that there are substantial â€” some would say embarrassing â€” inefficiencies in the system. And we have reason to believe that various steps â€” greater adoption of health IT, comparative effectiveness, better incentives for providers and patients, etc. â€” might be able to reduce those inefficiencies. But we donâ€™t know whether actual policy actions, with all their warts and blemishes, can actually tap into that potential and, if so, to what degree.
Policy should therefore focus on figuring out which policy interventions might work and learning how to calibrate them for maximum benefit. In short, policymakers should view health spending as an R&D problem. The goal is not to select the optimal policy once-and-for-all, but to set us on a path where we will learn what we need to know to make fundamental reforms down the road.
This article originally appeared on Donald Marron.