Word: treatments
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Dates: during 2000-2009
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...have implicitly if not explicitly adopted some form of cost control. In the U.S. you do it by not providing health care to some people. We are best known [for looking] at a new drug, device or diagnostic technique to see whether the increment in the cost of that treatment is worth the increment in the health gain. (See pictures of health care in Tehran...
...based on the cost of a measure called the "quality-adjusted life year" [QALY]. A QALY scores your health on a scale from zero to one: zero if you're dead and one if you're in perfect health. You find out as a result of a treatment where a patient would move up the scale. If you do a hip replacement, the patient might start at .5 and go up to .7, improving by .2. You can assume patients live for an average of 15 years following hip replacements. And .2 times 15 equals three quality-adjusted life years...
...Britain. How do you manage that? Our list price is used as a reference price in other countries, so drug companies believe that a no from NICE is damaging globally. So they set up what we call "patient-access schemes." Drug companies may either give away certain portions of treatment [such as the last few doses of a course] or reimburse the NHS for those patients who don't respond, which has the effect of reducing the price of the drug and lowering the cost per QALY - even though the reference price stays the same...
...help contain costs rather than inflate them? One argument is that having all that information available should make for better medicine and better medicine will be cheaper in the long run. But more information can also lead to less medicine. EMR can greatly increase insurance-company denials of the treatments doctors want. Might this eliminate unnecessary testing? Sure. But who determines what is necessary? When a white-blood-cell count isn't high enough to "justify" hospitalization for IV antibiotics, the physician whose judgment says "this patient is sick and belongs in the hospital" is told his services, as well...
Using information technology to figure out which treatments are most effective seems eminently sensible. Certain heart patients, for example, do just as well with clot-busting drugs as they would with angioplasty procedures, which typically cost thousands more. Crunching huge amounts of data from a wide cross section of patients could help us do better research than we are doing now. But what will happen when the new computerized research turns up a treatment that works a little better but costs a lot more? Will the government-sponsored researchers tell us? What happens to the patient whose particular circumstances argue...