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HEALTH CARE TECHNOLOGY

Delve into the technological imperative shaping healthcare costs, specialization trends in medical care, fallacies in quality assessment, and emerging funding tactics for cutting-edge medical advancements.

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HEALTH CARE TECHNOLOGY

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  1. HEALTH CARE TECHNOLOGY 13 February 2007 KATHARINE C RATHBUN MD

  2. COSTS • MONEY • TIME • LABOR • PAIN • INDEPENDENCE • LOVE

  3. HOW MUCH IS YOUR LIFE WORTH? • YOUR MONEY, TIME, ETC • SOMEONE ELSE'S • SOCIETY’S

  4. HEALTHY WORKER EFFECT • THE EMPLOYMENT PROCESS SELECTS FOR PEOPLE WHO ARE HEALTHY • THERE IS NO HEALTHY PERSON EFFECT ON BEING ALIVE • THERE USED TO BE

  5. LIFE EXPECTANCY / DISABILITY • 1966-1997 LIFE EXPECTANCY ROSE 2.8 YEARS • DISABILITY FREE YEARS PROJECTED TO DECLINE BY 7.3

  6. CAUSES OF DISABILITY • SAVING LIFE MAY MEAN INCREASED NUMBERS ON DISABILITY • ONLY SAVING BABIES CONTRIBUTES TO A DECLINE IN DISABILITY FREE YEARS

  7. TECHNOLOGIC IMPERATIVE • HAVE STATE-OF-THE-ART TECHNOLOGY • USE THIS TECHNOLOGY AT EVERY OPPORTUNITY

  8. MEDICAL SPECIALIZATION • SPECIALTY BOARDS WERE SET UP IN THE LATE 1940’s • MEDICARE AND HEALTH INSURANCE IN THE 1960’S • ALSO A TECHNOLOGIC IMPERATIVE

  9. SPECIALTY VS PRIMARY CARE • 1940 - ALL DOCTORS ARE TRAINED AS GENERALISTS • 1970 - 41% PRIMARY CARE • 1996 – 34% PRIMARY CARE

  10. PUSH FOR SPECIALIZATION • PAY MORE • BUY EQUIPMENT • ADDS PRESTIGE • WON’T HIRE GENERALISTS • ADVANCED PRIVILEGES • PEOPLE HAVE BEEN TAUGHT TO DEMAND SPECIALISTS

  11. PUSH FOR PRIMARY CARE • THIS IS GIVEN LIP SERVICE • LOWER PAY AND PRESTIGE • DENIED PRIVILEGES • WORK UNDER SPECIALIST SUPERVISION • GET HAND-ME-DOWN FACILITIES AND EQUIPMENT • USED AS GATEKEEPERS TO THE SPECIALISTS

  12. QUALITY OF CARE FALLACIES • TECHNOLOGY ASSESSMENT • DECISIONS ABOUT TECHNOLOGY ARE ABOUT QUALITY OF CARE • SENSITIVE SCREENING TESTS ARE GOOD

  13. TESTS • SENSITIVITY – LIKELIHOOD A POSITIVE TEST INDICATES DISEASE • SENSITIVE TESTS FOR SCREENING – Fewer false negatives • SPECIFICITY – LIKELIHOOD A NEGATIVE TEST INDICATES HEALTH • SPECIFIC TESTS FOR CONFIRMATION – Fewer false positives

  14. OUTCOMES • GEOGRAPHIC COMPARISONS SHOW THAT DIFFERENT TECHNOLOGIES MOSTLY DO NOT CHANGE OUTCOMES • MUST CONTROL FOR RACE, AGE, OCCUPATION, ETC

  15. COST CONTROL FALLACIES • UNNECESSARY TESTING/CARE • OLDER PHYSICIANS HAVE MORE INAPPROPRIATE ADMISSIONS • DRG’S WITH REDUCED PAYMENTS • OUTPATIENT VS INPATIENT • CERTIFICATE OF NEED • COMPETITION

  16. CLASSES OF DRUGS • OVER THE COUNTER DRUGS • PRESCRIPTION DRUGS • SCHEDULED DRUGS - NARCOTICS • SUPPLEMENTS

  17. DECIDING WHICH DRUG TO USE • DRUG MANUFACTURERS • DOCTORS IN PRACTICE • DOCTORS IN TRAINING • VIOXX VS IBUPROFEN

  18. INFORMATION SYSTEMS • ALL THE USUAL PROBLEMS • HIGHLY IDIOSYNCRATIC INFORMATION • HIGHLY “TECHNICAL” INFORMATION • HIPPA

  19. TELEMEDICINE • STORING AND TRANSFERRING INFORMATION • ISOLATED DOCTORS • GENERALLY ACQUIRING DATA IS THE PROBLEM NOT READING IT

  20. FUNDING TECHNOLOGY • MERGE WITH OTHER PROVIDERS • OBTAIN MANUFACTURER SUPPORT • BECOME A DEMONSTRATION SITE • BECOME A SERVICE CENTER • PONZI SCHEMES

  21. THE FUTURE • IT STILL TAKES 9 MONTHS TO MAKE A BABY

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