31 January 2011

Value of Health Care

At first I was considering just leaving this whole topic sit, but then the doctors had to start discussing it and basically doing nothing but quibbling. While I am not sure if I can add anything of value from a patient perspective, I would like to voice some concerns as a patient.

First, if doctors are so concerned with value, maybe patients should have more input. We may not be as independent or disinterested as a panel of stuff-shirted hospital board members or CEOs. We may have some concerns that are important to us and not the bottom line. I would suggest that missing is another New England Journal of Medicine (NEJM) article titled “Putting the Value Framework to Work”.

So I am drawing my ideas from two NEJM articles and one by Dr. R. Centor and comments to his blog. The second article mentioned by Dr. R. Centor is “What is Value in Health Care?” Dr. Centor's blog is “Measuring Value in Health Care”.

I must agree with Dr. Centor that “value” is a challenging topic. Patients should read it as well as doctors because this is something we will be facing in the near future and some are already involved and feeling the effects. I feel that Dr. Centor has taken the right path in discussing this in a positive manner. It is the law and will be part of our future for a while.

As such, Dr Center does correctly point out something in the article in the NEJM that is complex and has sophistication, and can be achieved. He also points out that the author of the NEJM article changes the focus to the patient and away from the system. This alone says volumes as too many doctors are so immersed in the system that they cannot see the patient. These doctors hide in the system so that they do not have to worry about the patient.

Dr Centor correctly points out that patients often have multiple physicians, use emergency departments, walk-in clinics, and hospitals. Patients do not use systems and may use physicians across several systems. The commentors are probably the doctors we want to stay away from. They seem ridged in their thinking and wanting to keep the current system. They are afraid that value means cost cutting which is not the object of the discussion.

Yes, value is often difficult to define under the current mode of operation. It will take getting out of the current system and probably into an Accountable Care Organization to make value something measurable and worth talking about. The ACOs are yet to be defined and may work, but there are some interesting questions still to be resolved.

Now that the house of representatives has taken their vote to repeal, we know that much of the Affordable Care Act may never be put in place because funding will quite likely be blocked. Some we know will be done in 2011, and more in the following years. We know that some of the better parts will move forward, but even then the court battle will probably not be resolved until mid-2012.

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