- First, the price of gas, generally trending up; in July 2008, it would have cost $131 to fill the Hummer’s 32 gallon tank. That sticker shock hit Americans a few months before the recession officially began in December 2008. But it was the season that ushered in Americans who once would never consider hybrid cars to take a look at them.
- Second, the recession itself. With the economic decline has come more Americans doing more at home, and if choosing to take vacations, opting for the “staycation.” That means driving more within a region, which means scrutinizing gas prices as a component of the total cost of the trip.
- Third, an ethos has begun to take hold with the American consumer: value-based shopping. More Americans are purchasing private-label goods from grocery stores and department stores. Today, value is in the eye of the purchaser.
In health, the 3 Hummer market dynamics translate as follows:
1. Health price sticker shock has meant higher hospital bad-debts when patients check out of ERs and inpatient beds, fewer prescriptions getting filled, and more recommended tests and treatments getting postponed or skipped.
2. The “staycation” metaphor in health is more health consumers doing DIY-health: sometimes for the better, often resulting in medical mistakes or mis-steps. Choosing to cut prescribed pills, for example, can be short-term fiscally smart, but in the longer term physically harmful.
3. Value-based shopping in health is largely a positive phenomenon when done with full information. The growth of generics has been fanned by both mail order pharmacy for chronic meds, as well as consumers’ response to $4 prescriptions for generics offered by big box discounters and retail pharmacies. Value-based care is also permeating the mindset of employers who buy health benefits on behalf of employees.
This week, as many as 30,000 attendees will walk the floor of HIMSS to kick tires on electronic health records systems, wireless devices, digital imaging systems, medical banking systems, and other technologies that will drive paper out of health processes. The intelligence of President Obama’s including $19 billion of stimulus funding in ARRA for health care IT was that, with those investments, over the longer term, the U.S. will be able to measure health care processes and outcomes. This will enable Medicare, Medicaid and commercial payers to sort out how much to spend, on what health care services, and to whom.
The promise of HIT, though, can’t do the heavy-lifting of healing health care alone without health payment reform.
Most Americans who get health care services are receiving Hummer-style healthcare: it may look fancy, with its innumerable bells and whistles, and perhaps by some be considered “the best in the world.” But under the hood, it’s incredibly wasteful and unsustainable.