Monday, December 21, 2009

Misconception – Healthcare reform will fundamentally improve how we receive care going forward.

This is also not at all likely except for those who do not now have medical care insurance. For the rest of us, medical care delivery will change but it will change not because of reform but because of some fundamental societal and demographic reasons along with a marked change in the types, severity and chronicity of illnesses that is occurring right now. The combination of an aging population and our non-healthy lifestyles (obesity, poor nutrition, lack of exercise, stress and smoking) are leading to epidemics of diabetes and heart failure plus increased numbers of cancers, kidney disease and others – diseases that are lifelong, complex and expensive to treat. What reform may do is protect those of us with “pre-existing conditions” to be able to purchase insurance and do so at a reasonable premium cost. And it may put an end to lifetime limits on insurance and the practice of “rescission” or dropping a person once they develop a serious illness. But the care itself and its delivery to us will probably not change much as a result of reform.

Here is some of what will change in the coming years irrespective of healthcare reform: There will be more people with chronic complex illnesses and these will require more drugs, more technologies, more testing, more imaging, more procedures and more hospitalizations – all of which will cost more money. There will be more hospital beds constructed, more operating rooms built, more intensive care units. At the same time there will be more and more that can be done as an outpatient as or with less invasive approaches than current surgery. There will be a need for newer pharmaceuticals and medical devices; these will be expensive but capable of reducing the cost of care if used wisely. Smaller hospitals will merge into systems to access credit markets so as to purchase technology and to enlarge physical plant. There will be greater use of eMedicine – telemedicine consults, moving medical information from site to site digitally rather than by courier, telediagnosis techniques such as digital weight or blood sugar recordings from home to the doctor’s office for review daily, and electronic submission of prescriptions and with it alerts to the doctor as to allergies or drug-drug incompatibilities.

These are but a few of the changes that are coming in the delivery of healthcare during the next five to fifteen years.

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