Improving health care access will increase costs

Back in July, New York Times columnist Aaron Carroll wrote a great piece for the newspaper’s Upshot blog titled “Why Improving Access to Health Care Does Not Save Money.”  It’s a great piece, and one that even the most ardent of Affordable Care Act supporters should read.

As Carroll points out, one of the ACA’s biggest arguments is that it will reduce people’s need for more intensive care by promoting preventive care, most of which it makes free.  The bottom line is that people will flock to primary care doctors instead of visiting expensive emergency departments for routine care.

There are so many flaws in that argument that it’s hard to know where to begin.  For one, increased preventative care doesn’t necessarily save the health care system money in the long run.  But as Carroll points out, and was often drilled into my head during my MPH years, all changes in the health care system involve trade-offs between cost, quality, and access.  An improvement in any part of this triad almost always results in some other aspect getting worse.  And improving access almost universally leads to higher costs – and may have disastrous effects on quality as well.  But let’s stick to access and cost.

The emergency department is an expensive place.  Unfortunately for those without insurance, it is often the only place to achieve care.  But even for those of us with insurance, the emergency department is often the most convenient place to receive care, especially on nights and weekends.  Having a larger proportion of insured patients isnt going to change the fact that visiting a primary care physician is still inconvenient, and unless that inconvenience changes, people will still go to the ER.

But lastly, there are a pool of people – including the uninsured, the underinsured, and some of the insured – who avoiding receiving care or didnt fully participate in their care because they couldn’t afford it.  With increasing access, these people will likely obtain the care they didnt get before – whether it be physician visits, visits to the ER, or obtaining medications.  In Massachusetts, which pioneered universal health insurance in 2007, expanded coverage was associated with a more than 9% increase in discretionary operations and a 4.5% increase in nondiscretionary ones.  If the Massachusetts experience provides any insight, a similar trend should be expected for the Affordable Care Act.

The bottom line is this.  Costs = units of service x price.  If you increase the units of service by making access easier, the overall costs will increase.  The real question though is whether this is a bad thing or not.  To quote Aaron Carroll, sometimes good things cost money.  If the increase in cost is also commensurate with an increase in quality, health, or well-being, it might just be worth it in the long run.

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Shopping on Amazon this holiday season?

If you plan on doing any of your holiday shopping on Amazon this holiday season, I’d like to persuade you to shop on Amazon Smile.

What’s the difference you ask?  For you, there’s no difference whatsoever.  But your shopping could make a world of difference to some incredibly important organizations.  Amazon will donate 0.5% of the price of your eligible Amazon Smile purchases to the charitable organization of your choice.

I’m personally supporting my good friends over at The METI Project, who do incredible work in Haiti.  Click here for more information on The METI Project, and here to shop on Amazon Smile for METI.

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Monday blues…

I’m guessing that “someone” might just be your boss… Happy Monday y’all.

monday gift receipt workday blues someecards

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naughty or nice?

The holiday season is definitely here.  Have you been naughty or nice?

Me?  I’ve just been sitting here… judging


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I’m on the day shift now, and singing is allowed!

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When we are silent about HIV, or stigmatize those who have it, we encourage and induce the spread of the epidemic.

~David Furnish

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World AIDS Day

December 1st marks World AIDS Day each year, a day that reminds the world of the incredible success in fighting this disease as well as the challenges that remain.  Despite amazing advances, there is still no cure for HIV/AIDS and a new person becomes infected with HIV every 11 minutes.

With all the hysteria surrounding the Ebola outbreak, only 2 people in the United States ever died from Ebola.  So why do we need to celebrate World AIDS Day?  Because the epidemic isnt over.  Because every year thousands of people in the United States become infected with the virus, and nearly a fifth of them remain undiagnosed.  According to the CDC, more than 1.2 million people are living with HIV in the United States, and 18% of them dont know they are infected.

We shouldn’t be talking about HIV/AIDS as if it’s a thing of the past, because it’s not.  It is very much here and present.  What we need to be talking about is an endgame, a way out – a way to stamp this disease out.  We need to be open and honest.  We need to educate our children about sex and teach them how to be safe.

And when all else fails, we need to embrace our friends, family, and loved ones who have fallen victim to this disease.  We need to show them our love and support, not our hatred and fear.

So this World AIDS Day, I urge you to go out and get tested.  Become educated, informed, and empowered.  So that we can end this thing once and for all.

For those of you in the Boston area, please visit the Aids Action Committee of Massachusetts to volunteer or make a donation at AIDS Action Committee of MA


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