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The greatest diminution in the cost of a given illness in the Western world has been achieved by reduction in the length of hospital stay. This has been accomplished by new medical and information technologies, new protocols of treatment, and innovative agents.
At the same time, any spending on new technology, and even more so on the mega-powerful systems of today, is considered expensive. Given this confrontation of perception, it is important to place new technologies in the framework of the global cost of poorly diagnosed, badly treated and inefficiently managed illnesses. For example, what is the cost to society, in all its parameters, for an episode of back pain that has been evaluated with modern scanning techniques versus that when the patient is evaluated by myelography followed by some of its simpler or even more severe complications?
Despite strenuous objections from entrenched groups, recent studies have shown and extensive clinical experience documented that new but appropriate technologies are also of benefit to healthcare in the less developed world.
This plenary session gave an overview and a cost analysis of the various groups of medical and information technologies with a view towards introducing the more detailed debates in the round tables which follow.
The technology that is best is that which diagnoses and treats the patient most effectively and expeditiously, with the least pain, and with the lowest statistical morbidity.
Confusing these considerations is the current fascination with “the empowered patient”, “knowledge of outcomes”, and “consumer choice”. These are however excellent goals and suggest that all participants in the care of patients must be knowledgeable. If the fundamental objective is to make the patient better, can medicine be practiced by a democratic committee of doctor and patient? Alternatively, can technology facilitate an improved relationship with clear lines of authority and efficient decision-making processes?
The three parties to this discussion were doctors, patients and payers. In an ideal world there should be absolute synchrony and harmony in the interests of the three. In today’s world that is unfortunately not the case, for many participants in the healthcare continuum seem to know the cost of everything but the value of nothing.
Historically, the well-trained and caring physician understood what the patient needed; the procedure or treatment was explained to the patient who, after discussion, usually agreed. The bill was submitted to the insurance company and it was paid.
Today trust is much diminished and the bills are much larger. Administrative costs have soared and an army of intercessors and interlopers has come between the parties. Recent studies have shown that in the United States administrative costs constitute 31% of healthcare spending. Patients tour the Internet and at times it is the physician who must give the informed consent to do the patient’s or the insurance company’s bidding.
The healthcare industry has been relatively slow compared to the financial world in adopting modern information technology, although it is a priori clear that to have done so at an earlier date would have improved the quality and efficiency of patient care more quickly. There are many reasons for this omission including the general feeling that patient data was intrinsically too complex to be handled in an anonymous and computer-driven manner.
Now, as so often happens, there is a sense of urgency to develop a full electronic medical patient record and to create the paperless hospital of the future – today. This is coupled with the medical “smart card” which each patient – perhaps every citizen – will carry as the ultimate national identity card. It will contain biometric information, the personalized genome of the bearer, and his or her financial and credit history. This may be the dream come true of the all-intrusive bureaucrat, but for the average man it is an Orwellian nightmare. What is the proper mixture? |
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 Plenary
Session: Innovation & technology: bridging outlays to savings
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| From Mars To Main Street – The current realities in medical technology The impact of emerging healthcare technology: Innovation, quality & cost The payer perspective Moderator |
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| Round Table
1: Which technologies are most useful for doctors and patients?
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| Round Table
2: Which technologies are most useful for insurers?
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| Round Table
3: Is the fixation on privacy limiting the effective use of information
technology?
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GMF | 2.0
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