Doctormanagedcare.com
Overview of Presentation
•   Money
•   Unsafe/ineffective tests and treatments
•   Under-funded important health care need...
Projected Health Care Costs
         for 2009 in Context
•   Projected health care costs: $2.7 trillion
•   Projected gros...
Unsustainable Cost of
     U.S. Healthcare
• $321 billion: shortfall in reserves set
  aside for post-retirement benefits ...
Inefficiency in Medical System
• $680 billion for administering
  medical care in 2009
• $500 billion at least for
  redun...
Comprehensive
  Health Care Reform
    Requirements
• Universal medical insurance
• Affordable cost
• High quality medical...
What is Quality Care?
• Compassionate
• Timely
• Evidence-based tests and
  treatments
• Good health care outcomes
Comparisons of Health
    Care Quality in 13
   Developed Countries
• Low  birth weight percentages—
  USA is 13th (last)
...
Evidence-based
      Medicine Principles
• Demand scientific evidence of safety and
  effectiveness for any medical interv...
RAND Corporation
  Quality of Care Report (2003)
• The RAND study premise: all
  guidelines for medical tests and
  treatm...
RAND Report (cont)
• The implication: Instead of $2.7
  trillion (17.6% of GNP) spending on
  healthcare in 2009, American...
Centralized Determination of
   Medical Practice Guidelines =
    “Money Driven Medicine”
1. Many medical orthodoxy-endors...
Table 1. Consequences of Tests and
   Treatments That Don’t Work in 2009
Test or Treatment        Deaths (minimum estimate...
Table 1. Consequences of Tests and
    Treatments That Don’t Work in 2009 (cont)
•    Test or Treatment Deaths (minimum es...
Under-funded Areas in American’s
    Dysfunctional Healthcare System
                            additional billions $ nee...
Total Cost of Fixing Health Care
  Without Comprehensive Reform
                                   $ Trillions
• Estimated...
Health Care Reform Conundrum
1. Incremental fixes won’t work
2. Comprehensive restructuring of our
   medical care system ...
The system is the problem;
not the people in the system.
Altruistic, dedicated, and talented
health care professionals exi...
Doctor Managed Care
•   Primary care physicians (PCPs) would become
    the managers of health care resources.
•   Each U....
Doctor Managed Care (2)
• Specialists would compete for referrals
  from PCPs
• Market forces would determine fair and
  j...
Doctor Managed Care (3)
• Each PCP would receive a capitated fee
  for each patient to cover all health care
  services.
•...
Funding Doctor Managed Care
• Employer Mandate—Bad Medicine, abandon it
• Federal Government funded but not
  government r...
Health Freedom
•    Honoring consumers’ rights to make their own
     personal health care choices
    1. Insurance withou...
Preventive Medicine
• $1.6 trillion in 2009 will go for treatment of
  chronic diseases that could be prevented
• Interven...
Doctor Managed Care
          Summary
•   Government funded—doctor managed
•   Market oriented—healthy competition
•   Mor...
Next Steps
• Replies/rebuttals from consumers,
  medical experts, politicians, health
  care policymakers
• A second editi...
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Doctormanagedcare.com Overview of Presentation

  1. 1. Doctormanagedcare.com
  2. 2. Overview of Presentation • Money • Unsafe/ineffective tests and treatments • Under-funded important health care needs • “Doctor Managed Care”
  3. 3. Projected Health Care Costs for 2009 in Context • Projected health care costs: $2.7 trillion • Projected gross national product: $15.2 trillion • Dept. of Defense budget for 2008: $623 billion • Health care as percent of GNP in 1993: 13.8% • Health care as percent of GNP in 2009: 17.6% • Health care as percent of GNP in 2015: 20%
  4. 4. Unsustainable Cost of U.S. Healthcare • $321 billion: shortfall in reserves set aside for post-retirement benefits for employees of U.S. corporations • $1.1 trillion: shortfall in health care services funds promised to employees of federal, state, and local governments • $32.4 trillion: the 75-year actuarial projection of Medicare debt
  5. 5. Inefficiency in Medical System • $680 billion for administering medical care in 2009 • $500 billion at least for redundancy and inefficiency • $83 billion or more for fraud
  6. 6. Comprehensive Health Care Reform Requirements • Universal medical insurance • Affordable cost • High quality medical treatment
  7. 7. What is Quality Care? • Compassionate • Timely • Evidence-based tests and treatments • Good health care outcomes
  8. 8. Comparisons of Health Care Quality in 13 Developed Countries • Low birth weight percentages— USA is 13th (last) • Infant mortality—USA is 13th • Over all years of potential life lost—USA is 13th
  9. 9. Evidence-based Medicine Principles • Demand scientific evidence of safety and effectiveness for any medical intervention. • Evidence of benefit in one clinical situation may not be relevant to another. • The lack of evidence that a treatment is effective is not equal to evidence that it is ineffective.
  10. 10. RAND Corporation Quality of Care Report (2003) • The RAND study premise: all guidelines for medical tests and treatments endorsed by a consensus of government and academic medical scientists are evidence-based and valid • The finding: Americans receive only 55% of tests and treatments required by official guidelines.
  11. 11. RAND Report (cont) • The implication: Instead of $2.7 trillion (17.6% of GNP) spending on healthcare in 2009, Americans should spend $4.7 trillion (29% of GNP). • Money Driven Medicine challenges RAND’s premise that medical establishment endorsed tests and treatments all benefit patients.
  12. 12. Centralized Determination of Medical Practice Guidelines = “Money Driven Medicine” 1. Many medical orthodoxy-endorsed tests and treatments are unproven to work or proven not to work 2. Paid for by public and private medical insurance 3. Risky (kill over 75,000 Americans/year) 4. Expensive (cost > $1 trillion in 2009)
  13. 13. Table 1. Consequences of Tests and Treatments That Don’t Work in 2009 Test or Treatment Deaths (minimum estimate) Cost (minimum estimate $billions) Interventions not following guidelines ? 271 Excess cesareans (Chapter 3) ? 17 Excess prematurity (Chapter 3) ? 14 Diet books, programs, and products for overweight and obesity (Chapter 4) ? 55 Drugs for obesity (Chapter 4) ? 2.3 Surgery for obesity (Chapter 4) 2,500 17 High cholesterol medications (Chapter 5) 15 27 High blood pressure meds (Chapter 6) ? 16 Tight control in type 2 diabetes (Ch 7) ? 23 Coronary artery bypasses (Chapter 9) 12,400 60 Angioplasty and stents (Chapter 9) 10,000 73.6 Coronary arteriography (Chapter 9) 1,400 53.8 Thrombolysis (clot busters) (Chapter 10) 2,100 0.5 Anticoagulants for leg/lung clots (Ch 11 1,000 15.2 Warfarin in atrial fibrillation (Chapter 11) 5,400 2.1 Warfarin for other things (Chapter 11) 6,000 2.3 Heparins (Chapter 11) 12,000 7.8 Antidepressant medications (Ch 12) 170 18.4 Screening PSA (Chapter 13) ? 3.9
  14. 14. Table 1. Consequences of Tests and Treatments That Don’t Work in 2009 (cont) • Test or Treatment Deaths (minimum estimate) Cost (minimum estimate in $billions) • Prostate cancer surgery (Chapter 13) 180 3.9 • Radiation for prostate cancer (Chapter 13) ? 2.8 • Screening mammograms (Chapter 14) ? 4.7 • Arthroscopic surgery (Chapter 15) ? 2.2 • Back pain tests / treatments (Chapter 15) ? 50.6 • Futile cancer chemo (Chapter 16) 2,000 46 • Futile treatments (Chapter 17) • (besides those in Chapter 16) ? 80 • Off-label prescribing of drugs (Chapter 18) ? 46 • Hormone replacement therapy (Chapter 19) ? 3.5 • Routine medical checkups (Chapter 19) ? 13.7 • Alzheimer's disease drugs (Chapter 19) ? 1.7 • Pap smears - no cervix (Chapter 19) ? 0.2 • The “war on drugs” (Chapter 19) ? 7.8 • Antiviral drugs for hepatitis C (Chapter 19) ? 1 • Unnecessary hysterectomies (Chapter 19) 250 12.4 • Diet supplements (Chapter 20) ? 28.8 • Unaffordable insurance (Chapter 21) 20,500 77 • Total 75,411 1,061
  15. 15. Under-funded Areas in American’s Dysfunctional Healthcare System additional billions $ needed in 2009 • Insurance for the uninsured $111 • Preventive medicine / health promotion 5 • Mental health care 174 • Addiction prevention and treatment 6 • Long-term care / home care / hospice 458 • HIV-AIDS prevention 10 • Compensation for victims of medical errors 1,200 • Electronic medical records 20 • Researching healthy lifestyle approaches 4 • Recruit and retain more nurses 2 • Patient “Bill of Rights” (CBO estimate) 16 • Total 2,006
  16. 16. Total Cost of Fixing Health Care Without Comprehensive Reform $ Trillions • Estimated health care costs for 2009: 2.7 • Additional interventions per guidelines: 2.0 • Paying for under-funded health needs: 2.0 Total 6.7 $6.7 Trillion = 44% of GNP in 2009
  17. 17. Health Care Reform Conundrum 1. Incremental fixes won’t work 2. Comprehensive restructuring of our medical care system is required. 3. Any comprehensive health care reform plan must address tests and treatments that don’t work. 4. Reform must also increase funding for many under-funded medical interventions
  18. 18. The system is the problem; not the people in the system. Altruistic, dedicated, and talented health care professionals exist in all areas related to healing the body, mind, and spirit. With few exceptions, medical and allied professionals want to improve the health of people.
  19. 19. Doctor Managed Care • Primary care physicians (PCPs) would become the managers of health care resources. • Each U.S. resident would choose his / her own PCP (Medical Doctor, Doctor of Osteopathy, nurse practitioner, physician’s assistant). • PCPs would have the authority to authorize insurance payment for any health care services • For desired services not PCP authorized 1. Pay out of pocket 2. Appeal to an oversight committee 3. Change PCP
  20. 20. Doctor Managed Care (2) • Specialists would compete for referrals from PCPs • Market forces would determine fair and just compensation • PCPs would have to authorize payment of pharmacy charges, tests, treatments, hospitalizations, and specialist bills. • PCPs would compete by funding beneficial services and not tests and treatments that don’t work.
  21. 21. Doctor Managed Care (3) • Each PCP would receive a capitated fee for each patient to cover all health care services. • Health services payments would be adjusted for each patient’s age, sex, medical diagnoses, and cost of sickness care in recent years. • For the average PCP: 1,000 patients x $7,100 per patient = $7.1 million in 2009
  22. 22. Funding Doctor Managed Care • Employer Mandate—Bad Medicine, abandon it • Federal Government funded but not government run • Possible replacement funding sources for approximately $1 trillion private insurance in 2009, mostly employment-based 1. Income taxes 2. Sales taxes 3. Payroll taxes (e.g., as for Medicare), 4. Targeted health care fees: • Tobacco • Alcohol • Guns • Junk food • Violent media • Fossil fuel
  23. 23. Health Freedom • Honoring consumers’ rights to make their own personal health care choices 1. Insurance without health care mandates from centralized guidelines 2. Choose health care plan by choosing the PCP 3. Faith-based insurance 4. Alternative care emphasis insurance 5. Health promotion approach insurance • Balanced with the need to protect the public from truly potentially harmful interventions • People need real choices—not HMO A versus HMO B versus PPO X…………
  24. 24. Preventive Medicine • $1.6 trillion in 2009 will go for treatment of chronic diseases that could be prevented • Interventions to reduce lifestyle-related diseases will cost insurance companies < $10 billion. • The food industry pays about $36 billion per year to advertise and market its saturated fat and cholesterol-laden food. • Doctor Managed Care would give PCPs and patients the incentives to fund health promotion.
  25. 25. Doctor Managed Care Summary • Government funded—doctor managed • Market oriented—healthy competition • More health freedom (choose your PCP) • Revenue neutral ($2.7 trillion in 2009) • Reduces funds for ineffective interventions • Increases funds for preventive medicine, long term care and other neglected priorities
  26. 26. Next Steps • Replies/rebuttals from consumers, medical experts, politicians, health care policymakers • A second edition that incorporates criticisms and suggestions from diverse health care stakeholders • Spread the word: doctormanagedcare.com

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