HEALTH CARE TECHNOLOGY

23 February 2006

KATHARINE C RATHBUN MD

COSTS

• MONEY

• TIME

• LABOR

• PAIN

• INDEPENDENCE

• LOVE

HOW MUCH IS YOUR LIFE WORTH?

• YOUR MONEY, TIME, ETC

• SOMEONE ELSE'S

• SOCIETY’S

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

LIFE EXPECTANCY / DISABILITY

• 1966-1997 LIFE EXPECTANCY ROSE 2.8 YEARS

• DISABILITY FREE YEARS PROJECTED TO DECLINE BY 7.3

CAUSES OF DISABILITY

• SAVING LIFE MAY MEAN INCREASED NUMBERS ON DISABILITY

• ONLY SAVING BABIES CONTRIBUTES TO A DECLINE IN DISABILITY FREE YEARS

TECHNOLOGIC IMPERATIVE

• HAVE STATE-OF-THE-ART TECHNOLOGY

• USE THIS TECHNOLOGY AT EVERY OPPORTUNITY

MEDICAL SPECIALIZATION

• SPECIALTY BOARDS WERE SET UP IN THE LATE 1940’s

• MEDICARE AND HEALTH INSURANCE IN THE 1960’S

• ALSO A TECHNOLOGIC IMPERATIVE

SPECIALTY VS PRIMARY CARE

• 1940 - ALL DOCTORS ARE TRAINED AS GENERALISTS

• 1970 - 41% PRIMARY CARE

• 1996 – 34% PRIMARY CARE

PUSH FOR SPECIALIZATION

• PAY MORE

• BUY EQUIPMENT

• ADDS PRESTIGE

• WON’T HIRE GENERALISTS

• ADVANCED PRIVILEGES

• PEOPLE HAVE BEEN TAUGHT TO DEMAND SPECIALISTS

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

QUALITY OF CARE FALLACIES

• TECHNOLOGY ASSESSMENT

• DECISIONS ABOUT TECHNOLOGY ARE ABOUT QUALITY OF CARE

• MORE SENSITIVE OR MORE SPECIFIC IS BETTER

OUTCOMES

• GEOGRAPHIC COMPARISONS SHOW THAT DIFFERENT TECHNOLOGIES MOSTLY DO NOT CHANGE OUTCOMES

• MUST CONTROL FOR RACE, AGE, OCCUPATION, ETC

COST CONTROL FALLACIES

• UNNECESSARY TESTING/CARE

• OLDER PHYSICIANS HAVE MORE INAPPROPRIATE ADMISSIONS

• DRG’S WITH REDUCED PAYMENTS

• OUTPATIENT VS INPATIENT

• CERTIFICATE OF NEED

• COMPETITION

CLASSES OF DRUGS

• OVER THE COUNTER DRUGS

• PRESCRIPTION DRUGS

• SCHEDULED DRUGS - NARCOTICS

• SUPPLEMENTS

DECIDING WHICH DRUG TO USE

• DRUG MANUFACTURERS

• DOCTORS IN PRACTICE

• DOCTORS IN TRAINING

• VIOXX VS IBUPROFEN

INFORMATION SYSTEMS

• ALL THE USUAL PROBLEMS

• HIGHLY IDIOSYNCRATIC INFORMATION

• HIGHLY “TECHNICAL” INFORMATION

• HIPPA

TELEMEDICINE

• STORING AND TRANSFERRING INFORMATION

• ISOLATED DOCTORS

• GENERALLY ACQUIRING DATA IS THE PROBLEM NOT READING IT

FUNDING TECHNOLOGY

• MERGE WITH OTHER PROVIDERS

• OBTAIN MANUFACTURER SUPPORT

• BECOME A DEMONSTRATION SITE

• BECOME A SERVICE CENTER

• PONZI SCHEMES

THE FUTURE

• IT STILL TAKES 9 MONTHS TO MAKE A BABY