Dr. Rob offers a worthwhile 3-part post on health care costs. He argues
that cost containment comes down to creating incentives for primary
care physicians to manage chronic illnesses more cost effectively.
The reason I focused on these diseases [diabetes, heart disease & AIDS] is that they all represent areas where good care is clearly beneficial. I won’t hit you with a bunch of statistics (they are easily found), but the bottom line is this:
- Well controlled diabetics have far fewer complications and hospitalizations than poorly controlled ones.
- A very large percentage of heart disease is preventable through relatively small interventions (Aspirin therapy, blood pressure control, cholesterol control).
- Appropriate treatment, screening, and prevention of HIV infection is cost-effective. (11, 12, 13)
As I say to my patients, it’s bad to wait until the oil light comes on in your car before you check your oil. A little intervention early can help a lot...
[T]he PCP is clearly best suited to implement preventive care and to manage patients with multiple chronic diseases. The PCP is a generalist, and has no financial motivation to have patients hospitalized (like hospitals do) or do procedures (like specialists do). Primary care is practiced in the outpatient setting, which is the least expensive place to do care.
But our system that rewards volume over quality makes it nearly impossible for most PCP’s to give the kind of care that chronically ill people need. Many of them would simply go out of business if they tried.