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HEALTH CARE TECHNOLOGY

HEALTH CARE TECHNOLOGY. 25 February 2008 KATHARINE C RATHBUN MD. COSTS. MONEY TIME LABOR PAIN INDEPENDENCE LOVE. HOW MUCH IS YOUR LIFE WORTH?. YOUR MONEY, TIME, ETC SOMEONE ELSE'S SOCIETY’S. HEALTHY WORKER EFFECT. THE EMPLOYMENT PROCESS SELECTS FOR PEOPLE WHO ARE HEALTHY

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HEALTH CARE TECHNOLOGY

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  1. HEALTH CARE TECHNOLOGY 25 February 2008 KATHARINE C RATHBUN MD

  2. COSTS • MONEY • TIME • LABOR • PAIN • INDEPENDENCE • LOVE

  3. HOW MUCH IS YOUR LIFE WORTH? • YOUR MONEY, TIME, ETC • SOMEONE ELSE'S • SOCIETY’S

  4. HEALTHY WORKER EFFECT • THE EMPLOYMENT PROCESS SELECTS FOR PEOPLE WHO ARE HEALTHY • THERE IS NO HEALTHY PERSON EFFECT ON BEING ALIVE • THERE USED TO BE

  5. LIFE EXPECTANCY / DISABILITY • 1966-1997 LIFE EXPECTANCY ROSE 2.8 YEARS • DISABILITY FREE YEARS PROJECTED TO DECLINE BY 7.3

  6. CAUSES OF DISABILITY • SAVING ADULTS OFTEN INCREASES NUMBERS ON DISABILITY • SAVING BABIES MAY BE WORSE

  7. TECHNOLOGIC IMPERATIVE • HAVE STATE-OF-THE-ART TECHNOLOGY • USE THIS TECHNOLOGY AT EVERY OPPORTUNITY

  8. MEDICAL SPECIALIZATION • SPECIALTY BOARDS WERE SET UP IN THE LATE 1940’s • MEDICARE AND HEALTH INSURANCE IN THE 1960’S • ALSO A TECHNOLOGIC IMPERATIVE

  9. SPECIALTY VS PRIMARY CARE • 1940 - ALL DOCTORS ARE TRAINED AS GENERALISTS • 1970 - 41% PRIMARY CARE • 1996 – 34% PRIMARY CARE

  10. PUSH FOR SPECIALIZATION • PAY MORE • BUY EQUIPMENT • ADDS PRESTIGE • WON’T HIRE GENERALISTS • ADVANCED PRIVILEGES • PEOPLE HAVE BEEN TAUGHT TO DEMAND SPECIALISTS

  11. PUSH FOR PRIMARY CARE • THIS IS GIVEN LIP SERVICE • LOWER PAY AND PRESTIGE • DENIED PRIVILEGES • WORK UNDER SPECIALIST SUPERVISION • GET HAND-ME-DOWN FACILITIES AND EQUIPMENT • USED AS GATEKEEPERS TO THE SPECIALISTS

  12. QUALITY OF CARE FALLACIES • TECHNOLOGY ASSESSMENT • DECISIONS ABOUT TECHNOLOGY ARE ABOUT QUALITY OF CARE • SENSITIVE SCREENING TESTS ARE GOOD

  13. TESTS • SENSITIVITY – LIKELIHOOD A POSITIVE TEST INDICATES DISEASE • SENSITIVE TESTS FOR SCREENING – Fewer false negatives • SPECIFICITY – LIKELIHOOD A NEGATIVE TEST INDICATES HEALTH • SPECIFIC TESTS FOR CONFIRMATION – Fewer false positives

  14. OUTCOMES • GEOGRAPHIC COMPARISONS SHOW THAT DIFFERENT TECHNOLOGIES MOSTLY DO NOT CHANGE OUTCOMES • MUST CONTROL FOR RACE, AGE, OCCUPATION, ETC

  15. COST CONTROL FALLACIES • UNNECESSARY TESTING/CARE • OLDER PHYSICIANS HAVE MORE INAPPROPRIATE ADMISSIONS • DRG’S WITH REDUCED PAYMENTS • OUTPATIENT VS INPATIENT • CERTIFICATE OF NEED • COMPETITION

  16. CLASSES OF DRUGS • OVER THE COUNTER DRUGS • PRESCRIPTION DRUGS • SCHEDULED DRUGS - NARCOTICS • SUPPLEMENTS

  17. DECIDING WHICH DRUG TO USE • DRUG MANUFACTURERS • DOCTORS IN PRACTICE • DOCTORS IN TRAINING • VIOXX VS IBUPROFEN

  18. INFORMATION SYSTEMS • ALL THE USUAL PROBLEMS • HIGHLY IDIOSYNCRATIC INFORMATION • HIGHLY “TECHNICAL” INFORMATION • HIPPA

  19. TELEMEDICINE • STORING AND TRANSFERRING INFORMATION • ISOLATED DOCTORS • GENERALLY ACQUIRING DATA IS THE PROBLEM NOT READING IT

  20. FUNDING TECHNOLOGY • MERGE WITH OTHER PROVIDERS • OBTAIN MANUFACTURER SUPPORT • BECOME A DEMONSTRATION SITE • BECOME A SERVICE CENTER • PONZI SCHEMES

  21. THE FUTURE • IT STILL TAKES 9 MONTHS TO MAKE A BABY

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