My point is Outcomes research has never been more crucial to health care reform then now. It is the final arbiter first mentioned to us by Florence Nightingale in the mid-1800′s and then E. A. Codman, an ortho in Boston who, even then, couldn’t get the hospitals to disclose their real data.

Joseph Nowoslawski commented on 12/27/11, “If….you want a ‘guaranteed success’ of outcome in a biologically uncertain and complex arena like illness (remember physicians get sued if the patient outcome is not perfect) then you have to pay for what you get. High quality costs high dollars.”

Don’t be so trite, Joe–paying for performance must take an acuity adjusted look at SPO. It cannot ignore both the ‘art’ and ‘science’ of medicine. For example, guidelines or standards must not be prescriptive (no cookbook medicine allowed here). We have to reduce barriers to care (the hassle factor, for instance, and also, patients should have some skin in the game, but not so much that they delay getting appropriate (medical necessary) care.

Why Bundling Payments Won’t Reduce Costs — Part 3: a blog from inside the emergency department

For related commentary see ManagingManagedCare.com (live but being updated).

Don’t people get that regulations have costs and those costs have to be paid by someone?

You want the answers to the question to reduce costs…here is is…stop regulating healthcare….open it up….(yes that includes not licensing physicians….and nurses etc) stop requiring hospitals to admit non payers and you will see costs drop….that is to say if all you want is cost control. If you haven’t guessed it already this is happening by letting professional assistants do physician tasks with encouragement of the regulators.

If on the other hand you want a “guarnteed sucess” of outcome in a biologically uncertain and complex arena like illness (remember physicians get sued if the patient outcome is not perfect) then you have to pay for what you get. High quality costs high dollars.

I can see the arguments on statistics coming forth…however…save your time and ask the question why everyone in the world wants to come to the USA to get their healthcare before quoting media dribble.

“The idea here is to get a large market share to adopt a payment model and then once that model has reached a “critical mass”, then turn around and use the widespread acceptance of that model to the disadvantage of the market.”

And it is not like they did not see it before…remember pre HMO days…..

Keep on writin….

I am not denying that someother countries have good models, but the reality is that people still pay for their care, and the care, most of the time, is at a level that would probably not be accepted by US patients, whoops, meant consumers.

most palces with socalised medicine, bundles payments, whatever you want to call it have
1) no malpractive, or low rates of malpractice awards
2) low to no cost for medical education
3) low to no cost of malpractice
4) HIGH taxes, approaching >50pct
5) limits on services, be they waitlists, controlling the number of docs allowed to practice, or some options and treatments which are just no offered

Also, the hospitals do not have the hotel quality that seems to be expected in the USA. 6 to 8 people per room or bay is common. curtains only separating patients. how woudl that go over with hippa here? usually private rooms are for people who are willing to pay extra, or have private health insurance. common bathrooms, hows that. dont believe me? check out almost any BBC show where they show the inside of a NHS hospital. I have never been there, but hear germany and france are even worse.

there is also a huge difference in ER wait times, forget being seen in 30 minutes or less as most US hospitals do. you ae lucky to be seen the same day. staffing is done by senior trainees, not fully qualified docs. that is how the costs are less, less trained people operate the system

this is not to mention the countless other ways that would not go over well given the myriad of US rules and regs.

please do your researchbefore saying how great things are in other countried. having worked in several system here and overseas, we have the best healthcare you can get, bar none.

I am not denying that someother countries have good models, but the reality is that people still pay for their care, and the care, most of the time, is at a level that would probably not be accepted by US patients, whoops, meant consumers.

most palces with socalised medicine, bundles payments, whatever you want to call it have
1) no malpractive, or low rates of malpractice awards
2) low to no cost for medical education
3) low to no cost of malpractice
4) HIGH taxes, approaching >50pct
5) limits on services, be they waitlists, controlling the number of docs allowed to practice, or some options and treatments which are just no offered

Also, the hospitals do not have the hotel quality that seems to be expected in the USA. 6 to 8 people per room or bay is common. curtains only separating patients. how woudl that go over with hippa here? usually private rooms are for people who are willing to pay extra, or have private health insurance. common bathrooms, hows that. dont believe me? check out almost any BBC show where they show the inside of a NHS hospital. I have never been there, but hear germany and france are even worse.

there is also a huge difference in ER wait times, forget being seen in 30 minutes or less as most US hospitals do. you ae lucky to be seen the same day. staffing is done by senior trainees, not fully qualified docs. that is how the costs are less, less trained people operate the system

this is not to mention the countless other ways that would not go over well given the myriad of US rules and regs.

please do your researchbefore saying how great things are in other countried. having worked in several system here and overseas, we have the best healthcare you can get, bar none.