The Optimistic Futurist: Prescriptions to cut health-care costs

  • Posted: Monday, October 22, 2012 12:01 a.m.
    UPDATED: Monday, October 22, 2012 6:34 a.m.

By Francis Koster†
I n 2011, each United States citizenís share of our total health-care expenses was $8,402. Most of us had almost no expenses; some of us had hundreds of thousands of dollars. This was roughly one dollar out of every six spent in the United States that year for everything! That is just about twice as much as the average citizen spends on food, which turns out to be $4,229 per person, per year.
There are two significant issues here. The first is that according to reliable studies done by experts from around the world, our health care costs twice as much per citizen as in other developed nations with modern health-care systems. The second is that with some notable exceptions, our results are worse than the cheaper systems. And to top it all off, in some parts of our country, life expectancy is actually going down.
You donít have to be a futurist to know we must do something to solve this problem.†
There are five major approaches to solving the problem of Americaís high health-care costs. They are pretty easy to understand.
First, we could have hidden rationing by creating a system where some people cannot locate a doctor or hospital to serve them, as is the case in many poor and rural areas, or by making health care unaffordable to poor people. Or second, we could have real rationing by not paying for things that donít work or bring little value. For example, we could limit government-funded end-of-life treatment choices instead of paying for heroic and painful measures in a person known to be approaching death. Multiple studies have found that 30-40 percent of all Medicare costs occur in the last year of life, much of it gaining only a few days or weeks before the funeral.
Third, we could cut the amount of money paid to hospitals and doctors for their services, in spite of the fact that in the last decade one third of all hospitals report they are already losing money, and this number is growing.
Forth, as a country, we could encourage and pay for prevention and health preservation through diet, exercise, vaccination and creating a safe environment. And fifth, we can improve the efficiency of the health-care process. Both of these pay handsome returns on investment.
Let me tell you about some locally implementable efforts to improve the quality and reduce the cost of health care of school children.
In Delaware, the Nemours/Alfred I. duPont Hospital for Children has a mature electronic medical record system, and a string of pediatricians who are affiliated with the hospital who use the same electronic medical record environment. The state also has around 200,000 kids in schools. The Nemours team partnered with the Delaware School System to develop a novel approach ó they would enhance communication across the continuum of care by incorporating the school nurse as part of the care team. With parental permission, the nurse is able to access NemoursLink, a web-based portal providing access to the Nemours electronic medical record.
The pilot project involved 11 schools in two school districts. The nurses focused on sick children who were high on their radar. Early indications are that allowing the school nurse and the doctorís office to share in viewing the common picture of the childís disease is valuable enough that the project is being expanded.
Another project is under way in Louisiana, where the Picard Center is negotiating with the state Medicaid program ó which covers 70 percent of the kids ó to create a common, parent authorized, electronic medical record system so that doctors, hospitals and school nurses can all see what the others are doing. A similar project done in Florida found that the school systemís costs of the project could be covered by the tuition dollars gained by having the chronically ill child well enough to attend school. (If a sick child misses too many school days, the school does not get paid their tuition from the taxpayer.) In other words, electronically connecting school nurses to the childís doctorís office resulted in healthier kids, lower health-care costs, higher school attendance, and both family and school system were better off financially.
Given the five choices for lowering the cost of health care, I would prefer to focus on prevention and efficient disease management, as these projects have done. The savings in dollars and suffering can be considerable. And it can be done locally, using tools now well understood.
In some cases, we donít need to fear the future ó we need to grab for it.

Francis P. Koster lives in Kannapolis. His ďOptimistic FuturistĒ column appears every other Sunday. You may contact him at

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