Data Does Not Make A Market
Kirsten Stewart continues her excellent reporting about Utah's health system woes (http://www.sltrib.com/sltrib/news/54957256-78/health-data-care-claims.ht...). Excerpts:
It was a data treasure trove promising answers to a question asked by health consumers everywhere: Which doctors, clinics and hospitals deliver the best care for the best price?
But Utah’s All-Payer Claims Database, a repository of all medical and pharmacy insurance claims filed statewide, has failed to deliver.
State Department of Health employees charged with building and overseeing the database have moved on to other positions in state government. The New Jersey-based vendor hired to mine the data, Care Advantage, went out of business last month. And promised reports comparing health centers on certain quality measures have yet to materialize.
But consumer advocates say what’s needed is more funding.
"If our leaders are serious about market-based reform, they need to get serious about funding the tools to make it possible," said Shelly Braun, a policy analyst at the Utah Health Policy Project. "As much as we think we can do things on a shoestring budget, at the end of the day, you get what you pay for."
Utah’s database was conceived in 2008 by a legislative health reform task force as means to arm consumers with the information they need to take charge of their health. It was intended to expose how much value patients receive from their insurance, how much they pay for tests and surgeries, and help them comparison-shop for coverage and medical care.
But Utah’s database was held out as an example of what can be done on the cheap.
While most states spent millions to get their versions running, Utah budgeted $800,000. At last count, the database contained more than 65 million insurance claims dating back to Jan. 1, 2007.
Most private insurers are submitting data. Next to be loaded are Medicare and Medicaid claims.
Last year the state paid the company $230,000, but no payments have been made since January 2012, Nangle said. "We haven’t gotten a bill from them."
Market-based reform is and always will be a pipe dream. Nothing about health care is like the prerequisites of a market. Even if this treasure trove of data had been made available to Utahns on-line, market forces will never shape health care delivery into efficiency. The private health insurance business model does not add value to health care delivery. No data base, all-payer or not, can change the basic fact about health insurance: overhead is massive making it the most wasteful method on earth for paying for health care. Even if Utahns could discover what is paid for tests and surgeries they can not comparison shop for the most expensive care, because that care is commonly delivered in urgent situations when 'shopping' is impossible.
I have participated in many health system reform panel discussions and debates. One physician who often also appeared on those panels and who always took the point of view that patients should be shoppers experienced a myocardial infarction. At a subsequent panel discussion, he described the experience as anything but shopping: lying on his bathroom floor with chest pain hoping that a well-trained ambulance would appear very soon and take him anywhere as quickly as possible. No time for shopping, comparing prices, understanding quality. There are literally hundreds of purchases made on behalf of a patient in those situations: which IV solution? which IV tubing? which medications? which heart monitoring equipment? which resuscitation device? etc. etc. Patients have no clue about any of these decisions. Pretending that a patient can actually make cogent purchases in the face of major trauma, burns, organ transplants, heart surgery, cancer, or urgent perinatal problems (or any of many other emergent conditions) is foolish. And yet, American health system policy remains linked to the idea that market forces will fix what's wrong in our health care delivery. Every politician of both major parties mouths this notion. 80% of the money spent on health care is and always will be spent by physicians and hospitals without any patient input, whether there is an all-payer data base or not.
Don't get me wrong. I very much favor carefully accumulating and reviewing data about health system performance. But the notion that this data will suddenly transform health care delivery into a marketplace where patients will shop for best value is a distortion which keeps us from actually reforming how we do health care business.
Dr. Joe Jarvis