Monday, July 27, 2009

How the price of health care gets pushed up

From the Washington Post:
Two decades ago, a famous clinical experiment showed that if a patient in the throes of a heart attack chewed and swallowed an aspirin tablet, the risk of dying fell from 13.2 percent to 10.2 percent.
If progress since then had come so cheap and easy -- a 23 percent improvement for an investment of three cents -- health care in the United States wouldn't be in the state it is.
In the 1960s, the chance of dying in the days immediately after a heart attack was 30 to 40 percent. In 1975, it was 27 percent. In 1984, it was 19 percent. In 1994, it was about 10 percent. Today, it's about 6 percent.
Over the same period, the charges for treating a heart attack marched steadily upward, from about $5,700 in 1977 to $54,400 in 2007 (without adjusting for inflation).
Although inappropriate care, high administrative costs, inflated prices and fraud all add to the country's gigantic medical bill, the biggest driver of the upward curve of health spending has been the discovery of new and better things to do when someone gets sick.
"When I was in medical school, about all we had to offer was oxygen, morphine and prayers," said Eric Topol, director of the Scripps Translational Science Institute in La Jolla, Calif.
Today, someone having a heart attack who gets to a hospital in time is likely to get cardiac catheterization, angioplasty, the placement of a medicated stent, therapy with four anticoagulant drugs and, on discharge, a handful of lifetime prescriptions.
The things that make a difference in survival rates include:
Aspirin -- 3 percentage point reduction in mortality -- 3¢.
Streptokynase -- 6 percentage points -- $300.
TPA -- 1 percentage point -- $1200.
Angioplasty -- ? percentage points -- $12,000.
Stents -- vanishingly small -- $600 - $2200.
It is safe to say that almost everybody who has a heart attack wants the best treatment available. Nobody wants to turn back the clock.
Well, not for themselves, anyway.

No comments: