Transcript HEALTH CARE TECHNOLOGY - DR

HEALTH CARE
TECHNOLOGY
25 February 2008
KATHARINE C RATHBUN MD
COSTS
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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 ADULTS OFTEN INCREASES
NUMBERS ON DISABILITY
• SAVING BABIES MAY BE WORSE
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
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PAY MORE
BUY EQUIPMENT
ADDS PRESTIGE
WON’T HIRE GENERALISTS
ADVANCED PRIVILEGES
PEOPLE HAVE BEEN TAUGHT TO
DEMAND SPECIALISTS
PUSH FOR PRIMARY CARE
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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
• SENSITIVE SCREENING TESTS ARE
GOOD
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
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
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OVER THE COUNTER DRUGS
PRESCRIPTION DRUGS
SCHEDULED DRUGS - NARCOTICS
SUPPLEMENTS
DECIDING WHICH DRUG TO
USE
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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
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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