De vez em quando, lá aparece alguém que pensa

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James Kwak, sobre a eficácia relativa de estratégias alternativas de redução dos custos na saúde:

"One refrain you heard incessantly during the health care reform debate was that we have high health care costs because of overconsumption and we have overconsumption because people don’t bear a high enough share of their marginal health care costs, so the solution is to increase copays and deductibles. (...) But (...) one large company that tried this year after year (...) only saw their costs going up. The problem was that while most members responded to the higher copays and kept their costs more or less steady, the 5 percent of members who generated 60 percent of the costs behaved differently. Or, rather, they also reduced consumption (of doctor’s visits and prescription medications), but as a result they often had catastrophic outcomes. These were people with heart disease on cholesterol-lowering medications, and when they went off their medications they ended up in the hospital with heart attacks and then with congestive heart failure.

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"It seems that for the people who consume the most health care dollars, you can save money simply by focusing on giving them better care — because right now their big problems are things like coverage gaps that prevent them from getting basic care, not being on the right medications, and ending up in the emergency room for catastrophic problems. Maybe for most people you would not save money simply by providing better care, but for the few people who consume most of the system’s resources, maybe you would save money. The problem is that with few exceptions, no one is trying to do that. That’s what we need an incentive for."

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