The other day, I learned about value-based healthcare.
The talk was given by a passionate UCSD faculty determined to change the status quo and fire up future physicians (like us MS1’s hungry for free lunch) against the corruption that favors the 1% of the nation and disfavors the 99% who are taken advantage by the insurance companies, pharmaceutical industry, hospital administration and even physicians themselves–sworn to protect and serve the patient at all costs.
The U.S. healthcare will soon takeover 40% of our federal budget by the mid 2030’s. Because physicians and the system is afraid to “cut corners” and
- For a patient suffering from excruciating pain, the U.S. healthcare system will help with and push $150,000 in chemotherapy that doesn’t do anything for thousands of end-stage patients but cause more pain. However, the same healthcare system will not provide hospice care which would cost only a few thousand dollars, which would do so much more for a patient in the last few weeks of life than hooking them up to painful chemicals. (I further clarified, they’ll provide drugs here and there and perhaps a visitor nurse to check on them, but will not provide a personal health aide)
- As a cancer patient, what would you rather do with $100,000?
- Avastin to extend your life for maybe 2-6 more weeks in the hospital
- Spend your time relaxed on vacation, traveling around the world, managing the pain, spending as much time as you can with your loved ones, etc.
- If you provide good palliative care, it is proven so many patients can and do live much longer. By simply managing the pain well. Some people are scared of opiates because of its abuse and mismanagement throughout the country’s hospitals. However, this is the one case where it is needed and where it’s deserved.
- Pharmaceutical companies are like animals: Do only what you can to survive.
- Mylan increased the price of a simple epipen from $57 to $600. No change in formula. Simply because patients relied on them and they monopolized the market.
- In a truly free market, a better product means the older less effective product should lower their price. Gleevec’s super drug increased the market from $26,000 to $146,000 even after better competitors entered the market.
- Insulin drug market is dominated by 3 companies and are under investigation for price fixing.
- Albendazole used to cost $6. It now costs $724 ($250 copay).
- Doxycycline used to cost $20. It now costs $1,849.
- What can we do as physicians to better care for our patients?
- Oncologists or physicians in general should never have an incentive in prescribing certain medicines. Oncologists currently have financial incentives for giving certain medicines. They buy certain anti-cancer drugs for a certain price, then they make profit by selling it at 3x the price. This would be fine, but what about the instances when a simpler, cheaper drug could be even better for the patient? What is the physician with debt more likely to prescribe to a trusting patient?
- U.S. hospitals will be paid to injure you. If you’re healed and out of the hospital in 3 days for a GI problem they get paid. If they rupture something in surgery, an infection erupts, etc. the patient stays another 2 months and the hospital makes 30x what they were originally going to charge the patient. There is no incentive not to harm the patient as quick, as efficient as possible.
- One neurosurgeon, Dr. Chris Duntsch, harmed patients for fun and drilled into spines nowhere near injuries. He was reported, but never stopped. It was always someone else’s problem. They didn’t want to be annoying to superiors. But he maimed and permanently injured and even killed dozens of patients.
A lot of these thoughts are sporadic here and there, but conclusively… I’m disappointed in the healthcare industry. Will I one day choose to turn a blind eye out of convenience?