Technology and Health Care

The problem with technology and health care is that technological advances seem to increase the cost of health care rather than decrease it. We got an amazing talk by Mark Smith, president of the California Health Care Foundation. In every other industry, technology decreases the price of goods and services; it gets cheaper and cheaper to buy a computer, make an international call, travel around the world, and buy GPS navigation. Yet in the U.S., producing a new MRI scanner or making a new kit or developing a new drug causes costs to skyrocket. Why?

There are a multitude of reasons; the cost of producing a drug that makes it to market is sky-high and patent protections prevent generics from competing. Although co-pays exist, consumers rarely bear the brunt of the costs so price has a blunted effect. But Dr. Smith brought up a very fascinating point, that the fundamental reason why technology doesn't reduce expenditures is a practice philosophy. We want the best for our patients and ourselves, not just "good enough." For example, a 64 slice CT may be good enough to diagnose appendicitis, but if a 128 slice CT is available, that becomes the standard of care. But this shouldn't be the case; the standard of care shouldn't be defined as the ceiling but as the floor. What is the minimum that guarantees safe, effective diagnosis and therapy? That should be the baseline. This way, new technologies entering the market must compete to make their added cost worthwhile. Right now, any technology, no matter the added cost, seems "better" than pre-existing equipment.

We need to stop hitting everything with a hammer. Compartmentalizing health care may also reduce costs. For example; patients shouldn't be going to the emergency department if there's no emergency. They shouldn't be going to acute care to get a pregnancy test. They shouldn't be getting prescription drugs when over-the-counters may suffice. Doctors don't need to be doing excuse notes from school or work, nurses don't need to be doing secretarial work. Doctors need to be diagnosing, nurses need to be triaging patients. We need to do the highest level of work that we are trained for; indeed, doctors are terrible at managing paperwork or fixing the computer system. Work efficiency is paramount to reducing costs.