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Journal of Community Health
Erschienen in: Journal of Community Health 6/2010

01.12.2010 | Original Paper

Further Opportunities for Cost Reduction of Medical Care

verfasst von: M. Malach, W. J. Baumol

Erschienen in: Journal of Community Health | Ausgabe 6/2010

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Abstract

The already high and still rising cost of health care has become a matter of serious concern and a subject of political dispute. The problem has no magic cures but, as is shown here, there are a number of promising modifications in current practice that promise to reduce the required outlays without impairing appropriate health care. Continual reports of new medicines, new tests, and new procedures have created an urgent need for careful comparison and evaluation of the advantages and beneficial results that these innovations offer. The same is true for the growing knowledge of genetic variations, which affects the course of therapy for some patients. Costs also can be saved, in some instances, by utilization of medical therapy, rather than interventional procedures. Preventive medicine provides still more opportunities for cost savings. This paper provides an overview of promising potential approaches to reduce the cost of health care.
Fußnoten
1
In the interest of thoroughness, some of the examples cited in our previous paper [2] are repeated here.
 
2
For instance, in testing new cardiovascular devices, the United States Food and Drug Administration premarket approval process has been found to be lacking in strength and also subject to possible bias, as noted in a report published in the Journal of the American Medical Association by Dhrunetal et al. (December 23/30, 2009, Vol. 302, pp. 2679–2685).
 
3
There is a large literature on statistical and econometric methods in which the pitfalls of the use of careless statistical evidence are spelled out. For an illuminating and amusing compendium of widespread economic misunderstandings resulting from careless statistical reasoning, see Freakonomics [9].
 
4
CT angiography carries with it a risk of cancer because of radiation exposure. There has been some diminution of radiation dosage in the process, but there is wide variability among institutions in this change. The number of all CT scans performed annually in the United States is estimated to be 75 million, as reported by Wachser in Newsmax (December 24, 2009).
 
5
The vasodilating flushing effect of niacin is largely minimized by the addition of aspirin, or by slow uptitration of niacin.
 
6
For example, Medicare allocates a hospital stay of four days or less for a diagnosis of uncomplicated heart attack. This policy grants no leeway for the care of unrelated, but associated medical conditions, like gout, peptic ulcers, urinary tract infections, or other non-coronary vascular occlusions.
 
7
It is noteworthy that as many as 40% of patients with heart attacks may not have an early elevation of cardiac enzymes in the presence of an acute coronary syndrome (ACS). Although they may have low risk factors for coronary disease, inflammation or infection may provoke an acute coronary vessel occlusion by rupture and embolism of an unstable, previously non-occluding atherosclerotic placque or coronary artery spasm [36]. This, then, later may be identified as a heart attack. An autopsy study revealed that placque ruptures and placque erosion are the source of emboli causing sudden death and heart attack before microscopic anatomic cellular damages became visible [37].
 
8
Now it has been reported that makers of brand name drugs have paid generic drug makers to delay the marketing of cheaper, alternative generic drugs. However, new health care legislation may curtail such agreements, which could save health consumers several billion dollars a year on prescription drugs (Singer, New York Times, 13 January 2010, pp. B1, B4).
 
9
In addition, red wines have been found to decrease tooth decay, as reported by Hubbard in Newsmax (January 8, 2010).
 
10
Elevation of HDL levels tend to lower LDL levels reciprocally.
 
11
Although arteriosclerosis was known for a long time to cause death in patients with coronary disease, no successful therapeutic treatment was available until the advent of statins. The accumulation of lipids and inflammatory cells in the walls of arteries is not newly discovered. Marchand in 1904, Ignatawsky and Neudauss in 1905, and Anitchvov in his classic paper in 1913 all connected the relation of cholesterol to obstructive atherosclerotic vascular disease. An editorial in 1958, by William Dock, published in the Annals of Internal Medicine likened Anitchvov’s discovery to that of the tubercle bacillus by Koch and Harvey [47, 48].
 
12
Biomarkers here are interleukin-1 receptor (ST2) and N-terminal pro-B type naturetic peptide (N-pro-BNP).
 
13
The use of diuretics as an essential medication for treatment of hypertension requires close and careful monitoring for electrolyte imbalance and dehydration.
 
14
The cost of defensive medicine is commonly thought to account for no less than 25% of all medical care costs in the United States. However, it is impossible to quantify these costs.
 
15
Related to defensive medicine are patient demands for specific tests or treatments that may not be necessary, which also contribute significantly to the costs of unneeded medical care and can be dangerous.
 
16
Epigenomes, which sit on the outside top of each gene, promote or quiet the expression of that particular gene. Environmental forces, such as starvation or overeating, can cause epigenomes to enhance or suppress a particular gene in a mother or father’s genetic material—ova, sperm, and the embryo in utero, thereby passing on a new trait to the next generation. This could explain some genetic mysteries, such as why only one member of a set of identical twins may develop asthma or bipolar disorder. Furthermore, as has been shown in animals, the addition of a methyl group can change the expression of a gene by increasing or decreasing its activation [84].
 
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Metadaten
Titel
Further Opportunities for Cost Reduction of Medical Care
verfasst von
M. Malach
W. J. Baumol
Publikationsdatum
01.12.2010
Verlag
Springer US
Erschienen in
Journal of Community Health / Ausgabe 6/2010
Print ISSN: 0094-5145
Elektronische ISSN: 1573-3610
DOI
https://doi.org/10.1007/s10900-010-9253-6

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