Sunday, December 13, 2009

Essay: Economical Medicine

To my readers:  I have been engaged in high-priority activities for my current client and have unfortunately neglected this blog.  I plan on publishing a flurry of articles from now to the end of this year.  Furthermore, I am re-initiating my review of patents and patent applications.


In this essay I discuss some of my observations regarding the US medical system.  I discuss what I consider could be the impact of remote monitoring technology on US medical practice.

I hope that people outside of the United States read my blog.  I provide my perspective as one US citizen about the US culture and medical practice.  I hope that others may chime in, and provide their perspectives regarding the US medical system, their own medical systems (if citizens of another country) and provided me with their perspectives.  

I argue that remote monitoring can provide high quality health care at a lower cost.  Remote monitoring provides lower cost health care primarily by keeping people out of the hospitals.  As a result, the huge infrastructure devoted to hospital will likely whither.  Hospitals will always have a place, but they'll become smaller and targeted to providing critical services such as trauma care, critical care and post-operative recovery.  People will spend less time in the hospitals, but physicians and automated care-givers will be able to monitor patients where ever they are located - mostly, away from the hospital.

But before I discuss my views on remote monitoring and it's place in economical medicine, I discuss my concepts of economical medicine.

Economical Medicine

My home is Chicago, Illinois, and over the last few years, I have seen a spat of new hospital construction.  Admittedly, there are areas where there are too few hospital beds and services.  I have been astonished by the amount of recent construction. It seems that the hospital are competing with each other to see who can provide the newest, most up to date hospital.  Furthermore, many of these same hospitals purchase the most expensive scanning equipment available and build large testing laboratories.

The United States provides some of the worst and the best medical treatment available in the industrialized world.  If you want something extra-ordinary performed, come to the US.  Where the US fails is providing mundane care to the majority of its populace. Our outcomes for the extraordinary are fabled, but the US ranks 37 in the WHO health care rankings behind countries such as Costa Rica, Columbia, Dominica, besides the obvious ones such as France, Switzerland, Austria, Italy, etc.

A landmark study published in 2000 showed that the US has the most expensive health care system in the world based on per capita and total expenditures as a percentage of gross domestic product.  

In 1998 the US spent $4,178 per person on health care in 1998.  The study median was $1,783 and the closest competitor was Switzerland at $2,794.  US spending as a percentage of gross national product was 13.6 percent. The countries closest were Germany (10.6%) and Switzerland (10.4%).  And things since 1998 have only gotten more expensive in the US to the point where the US care costs have reached crisis proportions.

Yet in the midst of an attempt to repair the US crisis, members of the US Congress, including nearly every member of the Republican party, have demonized any attempt to make the cost of health care more reasonable.  Particularly, when the costs of US health continued to increase at a pace that would eventually drastically lower the standard of living of the majority of Americans. Why is this?  

The roots of the opposition are clearly political and rooted in the economic interests of primarily the US health insurance companies.  Health insurance companies nearly own and operate many members of the House and Senate on matters of health care.  And these health care companies decided to declare war against any and especially a strong public insurance option - e. g., anything close to Medicare for the rest of us.  However, there is cultural resistance as well.

Culturally, Americans are profligate. We are a non-economical culture and that believes itself to have no limits.  Our sense of limitlessness is our greatest strength and weakness, and it has been running out of control for a long time. 

Americans build roads and cars instead of building trains and tracks.  We built muscle cars with large and powerful engines for decades instead of fuel-saving vehicles.  We built suburbs along our superhighways and commute long distances to work in vehicles that consume excessive amount of fuel.  We built large houses and houses with little insulation that consume excessive amounts of fuel to heat and excessive amounts of electricity to cool and light.  Growing up in this culture, my sense is that many Americans construe excess with the good life.  That need not be case.

We have a medical system that costs too much, delivers too little, places undue burdens on it's practitioners such as malpractice insurance costs and excessive paperwork.  In addition it has been perceived by a wide variety of players as a way to make massive, excessive amounts of money.  Getting fairly paid for a medical service, product or drug is a good thing.  Excessive payments can corrupt or bankrupt an entire system. 

Lower Cost Does Not Necessarily Equal Lower Quality

Over the past several decades we have be privy to a revolution, a revolution in ubiquity of computer power.  Compare the cost of an 1984 Apple Macintosh or a 1984 PC with one today.  The costs are either comparable or lower, but the computational power has skyrocketed from then to now.  Everything in the computational and communications sphere has increased while the cost has decreased.  Supercomputers and supercomputer availability, rare in the 1980s and early 1990s, has exploded in the last decade.  Sophisticated hand held computers with voice and data capabilities that dwarf the powers of 1990's desktop computer are available for hundreds of dollars.

Remote Monitoring

Remote monitoring is a minor outgrowth of the computing and data communications revolution.  It makes some use of the continuing computer and telecommunications developments, but so far, relatively little.  However, the potential is there as well as the interest in spreading the capabilities of the computing and communications revolution to the medical community.  In fact, I believe that many computer scientists and engineers consider medicine one of the last frontiers to thoroughly swept-up in this revolution.

Medicine by nature is a conservative discipline.  It deals with people's lives.  In the US there's the added problem of the legal profession and malpractice insurance companies breathing down a physician's neck.

I believe that the medical industry finally fully leverages the capabilities of the computer and communications revolution, medical costs will be lowered, people will spend either no or little time in hospitals.  Physicians will have the capability of tuning the dosages of medication in real time.  Sophisticated computer systems that have made use supercomputer models will be able to determine the medical status of a patient in real time or near real time.  These systems will be able to determine if a patient is showing signs of a pending medical crisis and requires intervention before the crisis appears.

All this can be available to the citizenry at a cost that would surprise you.  This is the ounce of prevention on a grand scale.

I shall continue to discuss economical medicine in future articles and how leveraging the computational and communications revolution will contribute to providing better medical care at a lower cost.

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