The application of industrial methods to cutting medical care cost seemed to make good sense. Doctors who were busy and had little desire to be administrators figured it would be best to let others do this type of activity. It did not take long before some of these money saving features intruded on the medical scene. I have tried to present a few of these money saving measures and how they have helped or hindered.
The first and simplest means of reducing cost is to increase number of units delivered. In the case of medicine this seemed simple and all that was needed was to have each physician see more patients. It was easily possible to schedule more patients per day for each physician. The result should have been less cost per visit. This did indeed happen but its effect on the overall cost of medical care had not been expected. The physician saw more patients but had less time to spend on problems. The amount of definitive care possible in a routine office visit decreased and the number of referrals increased significantly. Patients with multiple system diseases found it increasingly difficult to be fully heard.——- The result was more patient visits were needed, more consultations were needed and repeat visits became more frequent because the patients problem had not been fully addressed.——— The overall cost was not significantly reduced and may well have been increased significantly.
One of the other measures that were administratively worked out was cutting hospital care costs. The obvious way to cut costs as to cut the number of days spent in the hospital. If no IV’s were needed and monitoring was not needed the patient could be discharged. Another method that was to cut costs, was to assign a specific number of days for specific jobs. One method in which this was applied was to allow a specific number of days for particular types of service the hospital provided. By this means it was felt that it would provide a greater incentive for the hospital to make sure the patients were discharge as soon as possible. If they could be discharged in three days instead of the expected and allowed five days , the hospital would make more money. ——- The result has certainly been a reduction in hospital stays. More patients need further care and nursing homes or home care is needed. The other problem is lack of proper follow up for possible infections and no physical therapy which plays a major role in patient outcomes. Definitive care and required re-hospitalizations all contribute to affecting the economy adversely. ——–Another factor that had not been fully considered was that shorter hospital stays are associated with much nursing care and needs. I suspect that the overall cost per day has increased appreciably.
Medications is another costly problems. A variety of measures have been utilized to cit the cost of medication. The influence of the drug detail representative has been shortened or eliminated as much as possible. The prescription for 50 or 90 days is felt to be desirable.——- The result has not been great. Newer medications are not brought to the physician’s attention as soon as possible. While this may prevent the use of newer more expensive medication it also makes it difficult to try a medication for a day or two to see if the patient can tolerate it. Giving the patient 30 days supply may be somewhat wasteful in many cases.
I have no simple method of cutting medical care costs but I think it would be wise in the future to have physicians become involved in how medical problems can be addressed most economically.