<html><body><div style="color:#000; background-color:#fff; font-family:times new roman, new york, times, serif;font-size:12pt">Grist for the mill. From the NY Times:<br><br><div class="timestamp">January 21, 2012</div>
<h1>The Money Traps in U.S. Health Care</h1>
<h6 class="byline">By PHILIP M. BOFFEY</h6>
<div id="articleBody">
<div>
Why does an appendectomy in Germany cost roughly a quarter what it costs
in the United States? Or an M.R.I. scan cost less than a third as much,
on average, in Canada? </div>
<div>
Americans continue to spend more on health care than patients anywhere
else. In 2009, we spent $7,960 per person, twice as much as France,
which is known for providing very good health services. And for all that
spending, we get very mixed results — some superb, some average, some
inferior — compared with other advanced nations. Why this is true isn’t
easily answered. </div>
<div>
Health reform is supposed to control costs, but there is no simple
avenue of attack. Our aging population has played a role in driving up
medical costs, but Germany, Italy and Japan have much bigger percentages
of elderly people while spending much less per capita on health care.
</div>
<div>
The spread of health insurance, which shields patients from price
sensitivity, has played a role in driving up our spending. But almost
all other advanced industrial nations cover virtually everyone, while we
leave 50 million uninsured. </div>
<div>
Administrative costs are high here — no surprise given the hordes of
clerks and accountants needed to deal with insurance paperwork. And
technological advances, which are sometimes highly beneficial and
sometimes not, often cost a lot more than standard treatments.
(Surprisingly, American doctors lag far behind their counterparts abroad
in using electronic health records, which can help avoid costly errors
and duplications.) Insurance companies’ profits and the high pay of
their executives may account for some of the cost differences with other
countries, but there is little good data on this. </div>
<div>
A recent <a title="O.E.C.D. report (pdf)." href="http://www.oecd.org/dataoecd/6/28/49105858.pdf">report</a>
from the Organization for Economic Cooperation and Development, a
34-member group that includes the most advanced industrial nations,
concluded that spending is high here partly because the prices charged
by American doctors and hospitals are higher than they are anywhere
else. </div>
<div>
The International Federation of Health Plans, in its 2010 comparative price <a title="Full report (PDF)." href="http://www.ifhp.com/documents/IFHPPricereportfinal.pdf">report</a>,
documented just how large the price differential can be for a wide
range of services. While it’s difficult to get data that is truly
comparable from one country to another, the trends show Americans paying
a lot more than people in other countries for the same services.
</div>
<div>
Measuring how effectively we spend health care dollars is hugely
complicated. But cross-national surveys offer some clues. We’re good at
giving patients what they want — if they ask for it. So Americans can
see a specialist or get elective surgery a lot faster than patients in
other countries, according to surveys by the Commonwealth Fund. The
surveys also show that Americans are more likely than people in other
advanced nations to experience medical errors or problems with
uncoordinated care, and to forgo care because it’s too expensive.
</div>
<div>
The O.E.C.D. report rates America at or near the top for survival rates
in breast and colorectal cancer but slightly below average in cervical
cancer. We rank in the middle of the pack in the percentage of heart
attack patients who die in the hospital within 30 days of admission. And
we have alarmingly high rates of hospital admissions for asthma and
uncontrolled diabetes — an indicator that many patients don’t have good
primary care, which can prevent costly hospital stays. </div>
<div>
Most other advanced countries hold down prices through government
regulations. We set prices in Medicare and Medicaid programs. But in
private markets, reform has to rely on other means, such as financial
incentives for providers to curb costs by coordinating care and
improving efficiency. One demonstration program significantly reduced
spending by bundling payments to hospitals and doctors to cover all
in-patient services connected with heart bypass surgeries. </div>
<div>
The idea at the heart of the reform law is that such strategies, once
proved effective, could be carried out on a large scale — and eventually
bring total spending under control. </div><div><br></div><div><img
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