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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 third 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 III
Immediate and Long-term Savings
A system of R&D will stimulate a stronger relationship between the patient
and primary care provider (PCP) of their choice. This will encourage
well-being, preventive care, screening and early detection, prompt management
and monitoring of illness. The relationship will facilitate
decision-making regarding "Healthcare Proxy" and other
"Life-Sustaining-Treatment" choices. Such "written directives" are now mandated
in nearly all states.
R&D strongly encourages patients and providers (doctors, hospitals) to seek
community-wide and patient-specific cost-effective pathways to good health
with improved lifestyles. This leads to an immediate impact on the costs of
managing chronic illness which currently forms 75% of healthcare costs and
accounts for 70% of deaths. Half the population suffers from one or more
chronic illnesses, which can be prevented or ameliorated. Healthy living also
sets in motion a shift that decades from now will prevent and reduce the
incidence of many chronic illnesses.
The 47 million uninsured (27% of the population under age 65) and 6 million
under-insured receive care in the most expensive setting – the ER. (Another 66
million are uninsured for at-least one month in a year). These patients and
many of the working poor also cannot afford their medicines. These patients, in
the absence of a PCP, have little follow-up care or monitoring of their
illness. This makes ER visits a repeated occurrence. R&D will hopefully end
this practice. The "uncompensated care" of the uninsured is shifted to those
with insurance, raising their premiums by 17%.
Addressing end-of-life care will see an immediate improvement in costs. It is
reported that 27% of the Medicare budget is spent in the last year of life.
The Dartmouth Atlas Project reports that expenditure at the end of life ranges
from about $54,000 at the Mayo Clinic and Cleveland Clinic, to more than
$93,000 at UCLA, Cedars-Sinai, and New York University Medical Center.
Planners are confounded by such variations in the practice-patterns and cost,
with similar outcomes. The cost-comparison of these top hospitals discounts
technology as the culprit for high costs. Using accepted benchmark endpoints,
the "low-cost" hospitals provided better care. Dr. Gawande drew a similar
conclusion when he compared healthcare in McAllen with neighboring El Paso,
Texas. So too healthcare delivered in the mid-west states cost a lot less;
with no data suggesting it is inferior to that delivered in states east of
the Mississippi river.
The course and outcome of chronic diseases are generally predictable,
especially at the end-stage. The above studies conclude that patients in
"high-cost" hospitals spend more time in the last months of life, seeing
doctors (especially specialists) more often, are more frequently admitted to
the ICU and die in a hospital, than do patients at "low-cost" hospitals. A
greater tragedy is that such patients are more in need of TLC from their
families than in undergoing futile, yet expensive, treatments to change
disease-course. This is not an indictment of medicine, but the failure of our
modern fast-paced society and the absence of close family bonds. Doctors with a
caring staff can lay the groundwork for patients to reconnect and spend quality
time with family and friends. A high-tech facility staffed by highly-skilled
professionals is a poor substitute for a caring and loving home at life’s end.
The goal of the new healthcare system should not be to ration medical care but
rather to have a rational application of care - one based on proven science
and accepted practice patterns. The implementation of R&D will reduce the cost
of care by 20% - 30%, bringing it, as a percentage of GDP, in-line with or
lower than other industrialized countries.
