Will lower costs and greater access actually lead to better outcomes?
As the new administration settles in and begins their work on the many issues facing the country, many are looking to see if President Obama will follow through on his promise to reform healthcare. Listening to the various earnings calls which are now in full swing drug wholesalers and PBM’s see this coming reform as adding to their bottom line. The general consensus appears to be that advanced technology, such as; e-prescribing and electronic medical records will lead to lower costs. It’s also well known that several blockbuster branded drugs will soon be available as a generic which should lower costs even further. Finally candidate Obama campaigned strongly on his plan to make health insurance affordable, the question is will President Obama in tough economic times find the money to implement his ambitious plan.
Lost in all this discussion over the cost of healthcare is whether lower costs will actually lead to better outcomes. Just because a drug becomes cheaper when it’s available as a generic this does not guarantee that patients will actually take their medication regularly. Diabetes is a perfect example of this. Metformin is both cheap and effective, yet the fact remains that the majority of patients with diabetes are not achieving control.
This fact is the real reason why diabetes has turned into not only a healthcare crisis but an economic crisis is not because of the cost of treating diabetes. The real cost comes from poorly controlled diabetes which leads to numerous complications which end up putting the patient into the hospital. In the real world patient compliance with their daily therapy regimen is problematic. In the real world insurers would rather spend $30,000 for a leg amputation caused by poorly controlled diabetes then spend that same $30,000 on diabetes education which could prevent that several leg amputations.
Diabetic Investor is not against healthcare reform and like all Americans we’re all for lower costs, however providing an uninsured person with insurance only solves part of the problem. Healthcare reform that does not include an emphasis on patient education will do little to lower costs longer term. The fact is the majority of patients are non-compliant with their therapy regimen because they don’t understand the importance of taking their medications and monitoring their levels.
As Diabetic Investor has said many times even if glucose testing supplies were given away for free this would do little to increase testing frequency. Testing frequency will only increase if the patient understands what these numbers mean and what action they need to take as a result of these tests. The same is true with medications. Unlike other disease states where patients see immediate positive results from taking their medications patients with diabetes receive little if any positive reinforcement from taking their medications in the short term.
Contributing to the problem is the fact that nearly 80% of all patients are treated by a primary care physician who lacks the knowledge and resources to adequately treat their growing base of patients with diabetes. Therefore this emphasis on education cannot solely focus on patients but expand to primary care providers.
For as long as Diabetic Investor has been publishing we’ve heard calls for healthcare reform. Looking over the various proposals put forth the majority concentrate on lowering costs. Yet there is little hard evidence that lowering costs alone will improve outcomes while there is a mountain of evidence that proves patient education not only improves outcomes but lowers costs and increases productivity.
As a wise man once told Diabetic Investor; “Money only solves the problems that money creates.” Money or the lack thereof did not create the diabetes epidemic. While lowering the cost of healthcare is a step in the right direction it is merely the first step. To complete this journey to better outcomes education must be part of the reform.
