As we await the Senate’s iteration of a revamped health care bill, much of the pushback from the public has focused on health care access, while most of the House Republicans’ actions centered on health care cost.
What is missing from the conversation is any consideration of health care value.
What is health care value? The simplest definition comes in five words from Michael Porter at Harvard Business School: “Better health per dollar spent.”
Instead of demonizing health care costs, it is more instructive to the conversation currently vexing the nation to analyze how the cost of health care for a specific condition compares with the outcomes achieved.
An illustrative case study of health care value is the introduction of CT scanners to most emergency rooms around the country in the 1990s for evaluation of acute abdominal pain. Computed tomography, or CT, is a Nobel prize-winning technology that utilizes finely tuned X-rays and advanced computer processing to create detailed three-dimensional images of the body that enable doctors to make diagnoses without having to perform a biopsy or invasive surgery. Yet CT scans have been widely blamed for escalating costs of medical care.
In the early 1990s, when patients came to emergency departments for acute belly pain and appendicitis was suspected, nearly one out of every four appendixes that were removed were normal. This means one of four appendectomy patients underwent unnecessary surgery, racking up unwarranted health care costs and needlessly being put at risk of infection and complications. By 2006, when CT scanners were deployed in nearly every ER in the country, the number of normal appendixes removed for abdominal pain dropped to around 1 percent. Millions of people in the U.S. and around the world avoided unnecessary surgery.
Yes, the cost of technology and procedures is real — in California, the average CT scan charge runs about $1,400 (though actual reimbursement paid is in the $500 range), and that adds to the overall price tag of a patient’s care. But when we consider the value that this technology brings, we realize that undergoing a CT scan can actually cost less than not undergoing one in dollar terms, not to mention the quality of life when unnecessary surgery is avoided. Hundreds of millions of dollars and likely scores of thousands of lives have been saved by using this technology in the ER. Better health per dollar spent.
Unfortunately, the conversation about health care’s goals often tends to reverse the order, focusing first on cost, and then on patient health benefit. This approach is short-sighted. Regardless of our biases, each one of us will one day find ourselves a consumer of health care. It therefore behooves all of us to define value in terms of individual patient outcome, rather than in terms of health care policy for the masses, the bottom line of an insurer, or that of a hospital system.
Unnecessary surgeries have been greatly reduced; indeed, mortality, complication rates and costly hospitalizations decreased because of CT technology. Demonstrably, the introduction of CT scanners to the ER dramatically improved the standard of care in acute abdominal pain and appendectomy cases. No longer do hospitals and physicians accept the high rate of negative appendectomies and exploratory surgeries as existed in the early 1990s. The integration of high-quality advanced radiographic imaging changed what patients, physicians and hospitals expect of abdominal pain investigation.
CT created better health per dollar spent. Or, in Porter’s words, health care value. As CTs demonstrate, when determining the worth of providing access to care, value needs to be part of the equation.
Dr. Michael Brant-Zawadzki is the Senior Physician Executive at Hoag Memorial Hospital Presbyterian, and the Ron and Sandi Simon Executive Medical Director Endowed Chair of Pickup Family Neurosciences Institute. He is a former Director of Hoag’s Radiology Department.
To view the original article from The Orange County Register, please click here.
