Saturday, May 16, 2009

Flap's Dentistry Blog Links May 16, 2009


Obama aides talk about “game-changers.” These include improving health information technology, expanding wellness programs, expanding preventive medicine, changing reimbursement policies so hospitals are penalized for poor outcomes and instituting comparative effectiveness measures. Nearly everybody believes these are good ideas. The first problem is that most experts, with a notable exception of David Cutler of Harvard, don’t believe they will produce much in the way of cost savings over the next 10 years. They are expensive to set up and even if they work, it would take a long time for cumulative efficiencies to have much effect. That means that from today until the time President Obama is, say, 60, the U.S. will get no fiscal relief. The second problem is that nobody is sure that they will ever produce significant savings.

And he lays out a four-point plan for cheaper, better care: * Expanding health IT, “because we can’t improve what we don’t measure” * Conducting comparative effectiveness studies, “so doctors don’t recommend treatments that don’t improve health” * Emphasizing prevention, to “avoid costs associated with health risks such as smoking and obesity” * Changing the way doctors and hospitals are paid “so that they are incentivized rather than penalized for delivering high-quality care” These are all familiar ideas, and they are (of course) easier said than done.

THE number of people on the waiting list for an NHS dentist has almost tripled since Christmas. In York and Selby, figures show there were 1,250 people on the database for an NHS dentist for the final quarter of last year. But that jumped to 3,482 for the first quarter of this year. Coun Richard Moore said he was surprised the figures were not discussed at a City of York Council health scrutiny committee meeting. He said: “It’s a huge jump. I’m surprised there has been a jump of this size given the assurances of the primary care trust and I would be interested to know how it has come about as it was not brought out at the scrutiny meeting. From experience, I’m aware of people having to wait for treatment that they need and are being required to pay for it before they are even given an appointment.”

One of the most grotesque features of the charade that our new President refers to as “health care reform” is the pathetic groveling of various “stakeholders.” A particularly nauseating example can be found in the post at Kevin, MD by J. James Rohack, President-elect of the AMA: In an unprecedented endeavor aimed at achieving health-care reform this year, the American Medical Association (AMA) stood with President Obama and other key health-care stakeholders Monday to announce efforts to “bend the spending curve” on health care. The craven strategy Dr. Rohack and the other “stakeholders” have adopted in the face of a government takeover of the health system is to propitiate the monster in the hope that it will show mercy.

When we saw a story this morning about longer waits to see dermatologists, ob-gyns and orthopedic surgeons for non-urgent appointments in Boston, the first question that came to mind was whether Massachusetts’ universal health-coverage program had anything to do with it. It’s a likely factor, the Boston Globe reports. Expanded access to health insurance means more people have the financial means to heading to specialists to get care. Waits have gotten longer to see primary-care physicians as well. But the answer also isn’t that simple. Long waits to see doctors have been an issue for years in Boston, the Globe notes. Many specialists in the city work for large academic medical centers and don’t see patients full time. “We have an enormous emphasis on research in Massachusetts,” Brian Rossman, research director at patient-advocacy group Health Care for All, told the Globe. “And that influences the amount of time doctors have for patient care.”

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