Last Spring, NYC’s mayor Bill De Blasio promised to increase the wages of public workers while offsetting these increases with major savings on municipal health care costs. Now he’s released the details of his plan for realizing those savings, and perhaps surprisingly, it contains some good ideas. The NYT:
City officials and union leaders say they hope to push municipal workers to use walk-in clinics more and emergency rooms less, order generic drugs more often than brand-name ones, and buy them through the mail rather than at retail pharmacies to achieve bulk discounts.
The city hopes the unions will agree to steer workers to use centralized, cheaper centers for blood tests, X-rays or M.R.I.s, rather than having those tests performed in doctors’ offices or at costly physician-owned facilities. Patients who resist could face higher copayments, while savings would be passed on to the city in lower premiums.
When we’ve written about the importance of improving the delivery of health care, these are the sorts of changes we mean. When it comes to saving money on health care, De Blasio’s focus is right: not on price controls, but on encouraging a more efficient way of providing services. Many new technologies that could revolutionize service delivery are still only in development. But structural reforms like trading hospitals for clinics (for treating minor complaints), empowering nurse practitioners, and harnessing the power of the internet to buy in bulk or conduct digital checkups are also key.
The devil is in the details, and we’ll have to see how all this goes. But it’s an interesting glimmer of hope when the deep blue mayor of a deep blue city seems to take an approach like this to tackling spiraling health care costs.