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Health Care Humility
Don't Buy the Health Care Snake Oil

Health care reporting is often the art of picking out some trend that could help to improve our health care system if it ever gained traction—and then suggesting that a solution to our health care woes is therefore tantalizingly close. Take, for example, the lede of this WSJ piece on efforts by doctors and hospitals to make people more proactive about their own health care:

It’s the last mile in the race to fix health care—getting patients more involved.

Hospitals, doctors and public-health officials are pushing patients to keep track of their medical data, seek preventive care and stay on top of chronic conditions. They’re measuring how motivated patients are to manage their own health and adopting a wide range of strategies to help them do better, a concept known as patient engagement.

Here is the impression a lede like that leaves: we have almost fixed our health care problem (we are in the “last mile”) and all that remains for us to do is get patients more engaged, so that they’ll stay healthier and catch signs of illness before they become more expensive to treat. Hospitals are already busy working away at this, and presumably will soon see the benefits in lowered costs and greater efficiency. In fact, little of this is true, as becomes clear the further you read into the piece. Problems like provider shortages and stubbornly rising costs defy such cosmetic solutions. Obstacles to patient engagement run deep. The evidence that hospitals are working hard at patient engagement is all anecdotal.

Other sources make clear the ACA is having the opposite effect than supporters of patient engagement hope for. Yesterday USA Today looked closely at hospital admissions since ACA coverage went live in January. Hospital admissions are a good negative proxy for patient engagement: typically when hospital use spikes it’s because people have not been proactive about chronic conditions or primary care and go to the hospital once things get particularly bad. The story finds that admissions have gone up since January—in many places significantly.

We’d like to believe patient engagement is heating up: we’re big fans of technology that empowers Americans to take a more active role in their own health care. Pairing technology advancements with a more transparent and consumer-oriented health care is system is the key to lowering costs and improving quality. But though our national debate continues to suggest a technocratic solution is right around the corner, the reality on the ground in health care right now is chaos. We’d do well to remain realistic about the timetable and the limits still hedging in possible solutions.

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  • Andrew Allison

    “. . . the reality on the ground in health care right now is chaos” overstates the case. The reach and cost-effectiveness of healthcare delivery in the US is, or should be, deeply embarrassing, but it is hardly chaotic.

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