Technology will not save health care, personal responsibility will.

 

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During  President Obama’s speech he stated

“We will restore science to its rightful place, and wield technology’s wonders to raise health care’s quality and lower its cost.”

I completely, totally disagree.  President Obama, health care doesn’t need high technology, health care needs personal responsibility.  America’s health care costs are excessive for several reasons, and most have nothing to do with technology.  America spends 15% of it’s gross domestic product on health care, or from a different perspective,  $5711 per capita.  Our closest big spender?  The wealthy country of Luxembourg,which spends $4611 per capita.  Japan spends $2249, and Italy, where they eat all that pasta, spends $2314 per capita.  Why are we spending so dang much?

Here are the reasons, and they have nothing to do with technology:

  1. We Americans are pigs.  30% of our population is obese.  Note I said obese, not over weight.  We eat in our cars, chow on super sized fat filled “fast food”, and consider opening the refrigerator a sport.
  2. Television watching has morphed into an art form.  The average American watches FOUR hours of T.V. daily! Who has time to watch that much?!  In addition the wii is now considered a way to exercise.  C’mon, gimme a break!  The only way a wii can help you get exercise is when you walk the cardboard box it came in out to the garbage.  (Yes, I have played!)
  3. The Marlboro Man still rides.  Nearly 20% of Americans still smoke.  (Sadly, including our president.)  Those most likely to smoke were those below the poverty level, with the least amount of education, (and the least access to health care).

Sloth is causing Americans to be unhealthy.  High technology will make us more efficient in the way we diagnose and treat illnesses, but it will not prevent them.  Obesity, tobacco and inactivity are the root cause to heart disease, diabetes mellitus, many cancers, and  COPD.  The fanciest technology in the world will not change this.  What will?  America will spend less when we have sweeping cultural changes such that Americans get off the couch, toss away the remote, and spend their money on healthy foods, rather than cigarettes and french fries.

President Obama, I’m glad you’re here, but please, focus on the root of the problem.  Pruning the tree will not change the roots!

Next post: HOW we can create a healthier America with out expensive high technology.

Don’t Write Off E-prescribing

I may appear to be somewhat of a troglodyte, but I actually have  committed myself to learning to love technology.  I am the proud owner of a smart phone, have mastered my email, and actually use two different EMRs.  So, you see, this qualified me as an expert on EMRs and e-prescribing (wipe that smirk off your face!)

It was with interest that I read “Effect of Electronic Prescribing With Formulary decision Support On Medication Use and Cost” in the December 8/22 2008 issu3e of Archives Of Internal Medicineby Michael Fischer, MD, MS et al.  The authors describe a study in which physicians using e-prescribing with formulary decision support were compared with physicians using traditional paper prescriptions with respect to prescribing tier 1 medications.  When prescribing electronically, the physicians were more likely to choose the lower cost generic tier 1 medication.  There was a 3.3% increase in tier 1 prescribing, with a decrease in tier 2 and 3 prescriptions.  Fischer et al estimate that this would result in an $845,000 savings per 100,000 patients, based on the assumption that each patient filled one prescription per month.

I love saving money, but what was the cost of saving money?  According to the authors, “government estimates of approximate first year costs were $3000 per prescriber.”  In the study, Blue Cross Blue Shield supplied the software to the physicians, along with a free wireless device, access to a secure Web portal, licensing and wireless carrier.  So, the cost was not borne by the participating physicians.

I think as a first step toward an EMR, e-prescribing makes sense.  I do not think that every insurance company should provide physicians with it’s wireless device.  Can you imagine, five different devices for five different insurance companies?!

So what is to be done?  The federal government must mandate one SINGLE e-prescription system that we all should use, and insurance companies should bear the cost, based on percentage of patients enrolled in each plan.  Why should health insurance plans pay?  Because they are the ones that will enjoy the savings!  I think this would be an effective way to usher in the beginnings of an EMR.  Mr. Obama and Mr. Daschle, are you listening?

As physicians, we must look for ways that we can use e-prescribing efficiently and effectively.  We must commit to learning all the bells and whistles, and using it to our advantage.  So, stop hiding behind your prescription pad, and make way for what is inevitable.  Get out there and lobby for what should be done, rather than whining when we get handed the bill for something that will most benefit the health insurance industry!