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Healthcare Is Not an Insurance Product

June 27th, 2017 / Ray Pedden

I don’t know about you, but the political rhetoric around healthcare insurance has exhausted me. I am also very disappointed that few, if any, of the members of our government are being driven by any sort of objective data. Let me show you what I mean.

First and foremost — HEALTHCARE IS NOT AN INSURANCE PRODUCT.

I wish everyone that talks about what needs to be done would start from this point of view. It seems like 100 percent of all of the discussions are about insurance, while ignoring that insurance is at least one step — if not three or four steps — removed from healthcare itself.

Delivery of healthcare to individuals has been a data-driven activity since before the establishment of the first hospital in Philadelphia in 1751. Since 1970 there have been three sentinel events in this regard that have really focused on use of data in the treatment of patients:

  1. The problem-oriented medical record,
  2. The advancement of evidenced-based medical decision making, and
  3. The advent of the personalized medicine movement.

Dr. Lawrence Weed developed the concept of the problem-oriented medical record to provide a highly organized approach to the multiplicity of problems faced by clinicians on a daily basis. This development provided the foundation for many of the improvements in the delivery process.

I want my healthcare to be based on scientific evidence and not just the opinions and beliefs of a clinician that may have completed training a decade ago. The advancement of evidence-based guidelines has built upon the foundation laid by Dr. Weed and continues to ensure that many of us get the best care possible.

Finally, the personalized medicine movement brings all of this knowledge and expertise into focus for one specific individual — me.

So what results do we currently get from our healthcare system? According to the number crunchers at the Centers for Medicare and Medicaid Services healthcare spending is projected to grow faster than the US economy over the next decade.

TOTAL SPENDING $3.35 trillion
Per capita spending $10,345
# Primary care providers / 1,000 2.6
# Hospital beds / 1,000 2.9
Life expectancy
Men 71.5
Women 78.3
Infant mortality 10%
Average hospital stay 5.5 days
Drug costs $897 / capita
Hospital admissions / 1,000
Asthma 120
Chronic obstructive pulmonary disease (COPD) 203
Congestive heart failure (CHF) 441
Hypertension 49
Diabetes 57
Diabetes amputation 36
MRI scans 91
CT scans 228
Cancer mortality rates
Cervical 2.1%
Breast 20.7%
Colon 14.4%
Hospital fatalities
Acute myocardial infarction (MI) 5.1%
Hemorrhagic stroke 25.5%
Ischemic stroke 4.2%

What could we get if we rigorously applied data to our system instead of politics? I pulled comparative statistics from the Organisation for Economic Co-operation and Development, which tracks and reports on more than 1,200 health system measures across 34 industrialized countries. Here’s some comparative healthcare data from the 12 most industrialized countries:

TOTAL SPENDING $1.87 trillion
Per capita spending $5,765
# Primary care providers / 1,000 4.1
# Hospital beds / 1,000 8.2
Life expectancy
Men 73.3
Women 79.6
Infant mortality 6.8%
Average hospital stay 6 days
Drug costs $461 / capita
Hospital admissions / 1,000
Asthma 42
Chronic obstructive pulmonary disease (COPD) 192
Congestive heart failure (CHF) 188
Hypertension 52
Diabetes 19.5
Diabetes amputation 12
MRI scans 40
CT scans 108
Cancer mortality rates
Cervical 2.2%
Breast 23%
Colon 19%
Hospital fatalities
Acute myocardial infarction (MI) 3.8%
Hemorrhagic stroke 23.5%
Ischemic stroke 4.9%

We don’t even need to invent anything new to save $1.5 trillion per year. All we have to do is apply processes, policies, and data that have already yielded results to our delivery model.

I say we tell all of our politicians to sit down and shut up and we start today.

What do you say?