Where are the sweet spots in preventative medicine? When does preventative care really save us money rather than wasting it? When is it cheaper to pay for the uninsured so that hospitals don’t pass on their costs to the health insurance companies (and, thus, the insured) in the form of rising fees? When is it worthwhile to pay an extra nurse practitioner’s salary if they personally notice more problems and save their patients from having to make ER visits? These are all questions we should be asking more often. This article in the New Yorker by Atul Gawande points out some promising experimental systems where concentrating care on the neediest (say, the 1% of people on insurance who make up 30% of the costs) can save ER visits, hospitalizations, and millions of dollars in health care costs.
The critical flaw in our health-care system that people like Gunn and Brenner are finding is that it was never designed for the kind of patients who incur the highest costs. Medicine’s primary mechanism of service is the doctor visit and the E.R. visit. […] For a thirty-year-old with a fever, a twenty-minute visit to the doctor’s office may be just the thing. For a pedestrian hit by a minivan, there’s nowhere better than an emergency room. But these institutions are vastly inadequate for people with complex problems: the forty-year-old with drug and alcohol addiction; the eighty-four-year-old with advanced Alzheimer’s disease and a pneumonia; the sixty-year-old with heart failure, obesity, gout, a bad memory for his eleven medications, and half a dozen specialists recommending different tests and procedures.
I imagine that anyone with more than one health problem would agree. On the other hand, something like Dr. Fernandopulle’s clinic seems like just the thing that’s needed. THAT is the type of clinic I want to go to. And isn’t that part of the point?