Utilization

More gloom and doom on the health care economics and fiscal sustainability front. Or, choosing a more cheerful perspective, more great incentives for fixing our health care system.

The GAO in a recent report to the Senate Finance Committee added its voice to the Washington choir (in which CBO chief Peter Orszag and Fed chairman Ben Bernanke are the star soloists) warning that we are on an unsustainable fiscal path, and "over the long term, health care spending is the principal driver." That "we" is a big "we"—federal, state, and local governments, as well as the private sector. Like other top government agencies and experts, the GAO has recognized that the challenge is not merely demographics. Yes, with the Boomers retiring, we will have more older people, and older people develop health problems. But it's how they use costly (and sometimes unnecessary) health services, what the GAO calls "increased costs per beneficiary" not just sheer numbers of people that counts.

People are not getting the health care they need in America. They aren’t getting enough of the treatments that we know work and they may be getting too much of treatments with questionable value. This problem and how to resolve it is at the heart of reforming our health care delivery system, which is why we were glad it came up at last Friday's Alliance for Health Reform briefing on the topic of "Improving Care for Chronic Conditions."

Nora Super from Kaiser Permanente zeroed in on this issue after listening to Harvard's David Cutler present his last slide: "Implications: Under-utilization of effective, cost-efficient therapies continues to be a major public health challenge." She asked Dr. Cutler if he would agree that many patients are receiving unnecessary treatments, and more robust comparative effectiveness research is needed to examine what is over-utilized and what is under-utilized.