• On what efficiency enhancements would most health care experts agree?

    I posed a version of this question on Twitter. By “efficiency enhancement” I mean something that increases health at a cost we think is worth it or decreases costs without sacrificing more health than we think is worth it. (The ideal is greater health for lower cost, of course.) Answers, mine and some of those from others, are below, and in no particular order.

    Before you read the answers, it’s important to appreciate the form of the question. It does not ask what efficiency enhancements I or you like. It asks for those that we think most health care experts would agree on. We might think they’re bogus, but we think most such experts don’t. It’s also vague. What’s “most” and who’s an “expert”? Still, I think it’s interesting to try to contemplate where we might find common ground. See also my list on what most health economists might agree with.

    On what efficiency enhancements would most health care experts agree?

    • Focus effort on tertiary prevention
    • Focus effort on transitions of care
    • Payment bundling
    • More competition (Single payer advocates might disagree. But they should pay attention to competition in the NHS.)
    • The right kind of management (Look here.)
    • Checklists
    • Hand washing
    • Greater health literacy
    • Clearer/more complete practitioner-patient communication
    • Clinicians working at the top of their license/training (Meaning, don’t use more expensive practitioners where cheaper ones would do just as well, if not better.)
    • Streamlining payment administration
    • More comparative effectiveness information and use thereof
    • Less poverty
    • Price transparency
    • More public health investment
    • Pay more attention to social and environmental determinants of health

    If you think about some of these too much, they become tautological with “efficiency enhancement.” For instance, by “focus on transitions” we kinda mean “act so as to produce fewer errors and problems in transitions.” But that’s kind of like saying, “make it better” or “make it more efficient.” So, I think the right interpretation of some of these is as places to focus investment. If we invest more in care transitions (or tertiary prevention or health literacy or public health, etc.), we think better efficiency will follow. That is, they have positive ROI, we think, or we think most experts think.

    We should definitely debate these. We should do that on Twitter, of course.

    @afrakt

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