Danny Lieberman, founder of Pathcare, the online service for mindful sharing for support groups, considers inflection points for investment in technology for supporting for people.
Nothing is free in life, as noted by Robert Heinlen; who coined the expression: TAANSTAFL – “There ain’t no such thing as a free lunch”.
However – cost is not the entire question. The question is how can we make good “value based decisions when we invest in personal and public health”.
Cost versus effectiveness
In order to understand the meaning of “value based decisions” – we need to understand the difference between cost (“Getting a free lunch but not enjoying the food and feeling sick afterwards”) and effectiveness (“Paying for lunch, enjoying the food and feeling just right afterwards”).
Every business measures effectiveness and profitability but interestingly enough, managers do not always make value-based decisions. Purchasing decisions, decisions to buy or sell a stock or decisions to develop a new product are often made based on gut feelings without regards to the return on investment.
It is certainly reasonable to relate to healthcare like any other business – where you invest money and get returns by having healthier, longer-living people, who are more productive, happier, have less sick days, feel better, look better and produce more for their employer and their community.
But, effectiveness also implies that there is a cost side to healthcare for people – where an individual person must assume the cost and responsibility of being healthy.
The challenge for any value-based decision is finding the inflection point
At some point, the cost is too high or the return on investment starts going down. You can buy lunch for $500 – it doesn’t mean that you will enjoy the food or by happy afterwards – especially if you have to wash dishes for a week to pay for the bill.
Investment in good health, like anything else, has an inflection point where investing more resources leads to diminishing returns.
The health inflection point on a personal level
Working out 10 hours/week may be just right for you and you get enthusiastic about lifting weights, but 30 hours a week may cut into your work and family schedule and may eventually result in over-use injuries where you will need to stop and take a respite from the gym for 4-6 weeks as you heal. This is an example of how higher personal investment can result in dimishing health returns.
The health inflection point on a government level
Similarly at a government level – we would all agree that governments should invest in improving healthcare infrastructures and improving operations – for example by converting to a single-payer system and getting economies of scale. This is where government legislation and enforcement shines.
Inevitably however, more government spending on healthcare may reduce in less healthy people and diminishing returns because of churn, system overheads and the costs of running the bureaucracy to manage Federal healthcare programs.
Consider that increasing Federal spending on healthcare may result in Federal and healthcare organization decision makers to becoming blinded to low-cost solutions because they would be out of a job.
This is indeed a serious question in public healthcare policy.
Can we measure value-based healthcare?
A Dutch institute and US industry association are attempting to find answers to the question of how to implement value-based healthcare by looking at physicians, patient values and the entire care cycle:
The Dutch-based Decision Institute has developed a number of methodologies to implement the Value Based Healthcare from different perspectives: The medical condition, patient values, the care cycle, outcome measures, organization design, health costing, and value proposition. Through our masterclasses we provide ‘tastings’ of these methodologies, by which you can internalize the concept and get enabled to start improving your own healthcare delivery.
The US-based Healthcare Financial Management Association has Web-based clinical simulations allow clinicians to see how their medical decisions will likely impact care quality and cost—critical information as fee-for-service healthcare models are replaced by value-based models.
Hospitals and health systems will not meet their objectives without first changing the long-entrenched behaviors of clinicians trained to optimize their decisions in the fee-for-service model.
Don’t physicians and patients have responsibility for a good healthcare system?
It is easy to place the burden of responsibility for healthy people on the shoulders of the government, but good health starts with people and continues with physicians who are responsible for improving education and increasing compliance and outcomes together with their patients.
Over 20 patients a day die in the UK,from the superbug infections, MRSA and C difficile. It appears you have to spend money on new antibiotics if you want to save lives.
Vice-Chancellor of the University of Buckingham, Terence Kealey suggests that new research that characterises the key enzymes of MRSA and C difficile, will enable systematic development of new antibiotics for these two superbug infections.
Dr. Kealey is pessimistic that the bureacratic system of the UK NHS will be able to utilize the innovative drugs because that would cost money.
Although Kealey appears to prefer a more privatized system of health – looking at trends of healthcare spending in the United States during the past 4 years of the Obama administration, it is not clear that more Federal spending is helping make Americans healthier by eating better and walking instead of taking the car.
Why big federal spending on healthcare will not make Americans healthier
US spending on Obamacare will cost the US taxpayer 1 Trillion US Dollars over 10 years. Serious efforts are being made to collect metrics on meaningful use and measure effectiveness – this is the good news.
The bad news is that US public expenditure per patient is over twice that of Norway although both countries have comparable numbers of hospital beds per 1,000 (numbers courtesy of the World Bank).
Using the Norway example, US Federal government spending on healthcare may already be past the inflection point of diminishing returns.
The solution for better health starts with personal responsibility
The solution for better privacy and healthier citizens lies in individuals adopting simple, practical methods like walking instead of taking the car and eating vegetables instead of industrial-prepared food like chicken nuggets.
There are simple and cheap solutions for being healthy
Your mom was right when she told you to wash your hands before eating and get a good nights sleep on a school night.
On the island of Ikaria, people drink wine at breakfast, lunch and dinner, go to bed late but wake up naturally and live a simple life with lots of goat milk, locally-grown vegetables, cold-pressed olive oil and just a little meat once/week.
Ikaria is an island off the western coast of Turkey, home to almost 10,000 Greek nationals. What’s remarkable about these people is that they live extraordinarily long lives; it is not uncommon to be passing 100 year-olds on the street. See the Island where people forget to die.
And perhaps we should all take a lesson from the people of Ikaria before rushing to implement “simulations for value-based healthcare.”