A Model for Health Care That Pays for Quality - page 3

seeing low fees for family doctors as a weak link in the nation's health care system, some big employers and health insurers are seeking new ways to pay doctors to reward high-quality medical care.... Read More

  1. by   lamazeteacher
    Dria, did you really get from my message, that I was requesting the only medication that relieved my painful symptoms, as frivolous or uncooperative? That was not my attitude, I simply wanted relief that came from one drug, and not others I'd tried, which was what the insurance company demanded I do! I am entitled to relief of pain, if there's a medication that will do that! If not for meeting patients' needs, what ever else is healthcare for?
    As far as Canada's healthcare system is concerned, it works, now and at its inception. I was there when it began, and my family is still there, getting excellent care.There are the rich patients who, as you described, "want what they want when they want it", who go across the border for it, and pay privately. They only wait for procedures, if it is safe. Diagnostic tests are done far more freely than they are here. My neice, a physician there, said, when I told her that radiological studies were deferred for me, due to their cost, she said, "oh, you do have to think about that there.....", pensively. She never prescribes an antibiotic without taking a culture of whatever she can get, first. When I had pneumonia and was treated empirically despite copious sputum, she was appalled.
    The doctors there make considerably less than American ones, and complain about that mightily, especially after coming home from American held conferences feeling economically deprived, due to American counterpart boasting of their high incomes. However, their lifestyles compare nicely to that of American doctors.
    The hospitals and clinics there save money by appearing quite institutional, compared to ours, that vie in appearance with luxury hotels. Patients who are acutely ill, are not impressed with their surroundings, they just prefer the appearance of someone who will comfort and assist them by getting their pain medication, change the IV container so it'll stop awakening them with its jangling, and take them to the bathroom in a timely manner. I think our decorator driven hospital accoutrements, please administrators and Boards of Directors, but certainly the money spent on them isn't warranted.
  2. by   HM2VikingRN
    The point is that Doctors can request formulary exceptions to get drugs approved for patients.

    Prevacid is a good example of a drug that in our market driven health care system is way overpriced. In Mountains beyond Mountains there is a description of 4 different off patent antibiotics that are needed for tx to mdr/tb. In Paris these drugs cost on the order of 8 dollars per vial. In the US they were 29-30 dollars per vial. What is disturbing about figures like this is that the basic scientific research for the majority of drugs in the US was paid for by tax payers.

    In an evidence based reimburseement system prevacid would receive the highest level of coverage while a less proven drug may only be reimbursed at 30% of cost. (See Health of Nations by Ezra Klein for a description of how this system works in France).

    Catastrophic only coverage is more expensive in the long run. One of the reasons that the countries with Universal coverage achieve better health outcomes is that they place the emphasis on screening, primary prevention and treatment of illness rather than cure. Patients are notoriously bad at choosing which health care to forgo under a market driven system. (In other words they will skip HTN or DM medications for cost reasons just as often as they do worried well visits to providers.) The cost for cardiovascular disease treatment in the US is well over 100 BN dollars per year. Ideally within a medical home system patients are diagnosed early in the diseases process, given EBP based treatment which slows the progression of the disease process which results in improved QOL and reduced medical costs.
    Last edit by HM2VikingRN on Nov 14, '07
  3. by   dria
    you are correct in stating that doctors can request a formulary exception. making such a request does not ensure approval. i have seen this occur in countless cases. benefit exceptions are in fact becoming more rare in order for the insurer to protect itself from legal action against those who are denied. i'm not saying that i think this is right or wrong, just how it is.
    lamaze, i apologize for sounding callous. i am not insensitive to your discomfort. i will consider the point i was trying to make, and how to word it in a manner which does not offend. i offer my apologies once again.
  4. by   HM2VikingRN
  5. by   lamazeteacher
    Those are fascinating figures, especially Japan's, since that country's priority is cancer affecting males - at least in 1984, it was. I collected information for a paper then, (while on a year's odyssey to 26 countries), about women's attitudes toward their healthcare. When I went to the Japanese Cancer Society to ask about the rates of breast cancer, the doctor with whom I had an appointment said, "We don't follow that, as stomach cancer affects men, so we are more concerned about that"!!!!!!!
    I can only think that late detection of prostate cancer is happening in New Zealand and the USA, and particularly in the UK and France (50% mortality!). I wonder if men have the check ups covered by the national medical plans there, and if so, whether their doctors perform rectals and blood tests for it.
    The high incidence in NZ, Canada and the USA could be studied for cause, with comparison of men with high and low stress....... "'tis a puzzlement" (from Anna and the King of Siam.
    Thanks again, HM Viking for bringing that to our attention.
  6. by   CHATSDALE
    japanese women have a lower rate of breast cancer probably due to lower rates of obesity and genitic concerns but mens concerns ae given priority world wide given the fact that men go to md less often than women so that doctor discovered problems are propably not the significant factors
    i went for a routine doctors visit yesterday..he only touched me once [when he took my b/p]

    who determines if a patient is getting quality..on this board it has been determined that patients do not have the smarts to determine if they need a spiecialists opinion, or to determine if a med is effective or not
    as for canada's level of care i have heard from both sides with completely different views..one of this negative concerned a mammography in a woman with frightful history of mother, sister
    two aunts and a grandmother based on age