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Goanetter Francis Rodrigues (Vasco/Toronto) book launch in
London, England @ the World Goa Day festivities on 15 Aug at 7pm
Details http://www.konkanisongbook.com
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This is the second of a four-part article that will be posted on Goanet for
general information. Constructive comments are most welcome; and will help me
polish this article before I send it for publication.
Comprehensive Healthcare -
Empowering the front-line of Medical Care.
Part II
Rewards and Disincentives (new R&D)
Healthcare reform needs to think out of the box without re-inventing the
wheel. The past tells us that fragmentation of the system causes gaps and
exacerbation of irrationalities at every step in healthcare delivery. Delay in
reform only compounds the problem, as seen by the fallout in the domestic auto
industry and bankruptcy of GM - world's largest corporation. Auto management
and UAW unions were reportedly one of the first groups to torpedo Clintons'
healthcare reform. As Congress debates mechanisms for reimbursement, physicians
should debate grass-root delivery of care, without demagoging the alternatives.
If doctors do not take control of healthcare delivery, others will dictate the
terms. Planners needs to develop a new R&D, best suited for America, and if
needed, specifically targeted to regions.
The most logical step is for medical organizations, through scientific studies,
develop accepted benchmarks and "Best Practice" patterns, many of which already
exist, but not universally implemented. More research efforts, dollars and
scientific papers should be devoted to the study of cost-effectiveness of
various treatment paradigms. Work on "comparative effectiveness research"
(CER) has received impetus with recent federal funding. Knowing the
effectiveness and economics of various alternatives will help doctors and
hospitals to better practice and accept, or counter, directives of
healthcare-insurers; who are positioning themselves as "healthcare-managing"
corporations. These corporations will likely consume even more of the premiums
as administrative costs.
A parallel step is for existing authorities to develop R&D (a new acronym) for
all stake-holders, including the public, to promote evidence-based,
cost-effective medical care. While organized medicine and others eagerly
seeks carrots, few propose disincentives for poor practice-patterns.
Itemized computer billing and electronic medical record (EMR) lends itself to
biometric analysis, making it easy to detect poor
practice-patterns. Non-payment of charges is probably the best incentive to
stop inappropriate care, with the quickest response-time for change. It is
less punitive than fines or malpractice lawsuits. To reduce incentives
for "volume" of care, some suggest use of "bundled reimbursement." This
approach needs to be structured and monitored, as should other benchmarks,
to prevent undesirable gate-keepers - medical or bureaucratic.
