The 800-pound gorilla of health care reform

The Minnesota Department of Health is continuing to plow into the details of reforming the state’s health care.

It’s the public’s turn today to provide feedback at a meeting in St. Paul, hosted by the Health Department, on a plan to develop cost and quality comparison data. 

Here’s what it’s all about: As part of Minnesota’s 2008 health care reform bill, the Health Department has been asked to develop a "provider peer grouping" system. "Encounter data"  must be collected to give an overview of what kinds of health care services are being used and how much they cost. (You can read more about this initiative here.)

The idea is to help consumers compare cost and quality so they can make sure they’re getting good care that also gives them their money’s worth.

Few people can afford to be unconcerned nowadays about the cost of health care. The cost keeps going up; according to state figures, health care spending in Minnesota increased from $19 billion to almost $31 billion between 2000 and 2006.

How some of the current state initiatives will play out, however, is anyone’s guess. I confess to being disappointed that the Health Department has chosen to hold its one and only meeting on the encounter data proposal in St. Paul, during the day (2 to 4 p.m.) when most people are at work. Will so-called ordinary consumers be able to attend? (Clearly they’ll need to do some homework first if they want to contribute to the discussion; I had to do a fair amount of reading to gain even a basic grasp of this proposal.) What about people from rural Minnesota?

Rural Minnesotans have a considerable stake in this. Outside the Twin Cities area and possibly Duluth, Rochester and St. Cloud, the health care market doesn’t function in quite the same way. The market is smaller, hospitals are smaller, health care professionals are in shorter supply, and people often are traveling farther for certain kinds of care. It’s hard to picture how a rural patient, faced with the need for surgery or for chronic care, will genuinely be able to choose where to receive care on the basis of cost and quality.

Are these differences between rural and urban health care being recognized by the health care reformers? I hope so, but I don’t really know if this is truly the case.

More to the point, it’s not at all clear whether consumers will be prepared to use cost and quality data in a meaningful way – or whether the system will be ready for them to do so. This was evident in a recent story reported by the Star Tribune of Minneapolis: An uninsured patient was seen at an urgent care clinic for a severe cough, was told she needed a CT scan and sent across the street to the hospital for the procedure. She wanted to find out first what it cost, but by the time an answer was provided it was too late – she’d already had the scan and was billed $780.

In hindsight, it’s easy to say she should just have refused the scan. But patients aren’t necessarily in a position to judge whether a CT scan is clinically appropriate. Maybe she could have shopped around, but this was the hospital to which she was sent. People who are sick can’t always be expected to check the prices at three or four different vendors before making their choice. In rural Minnesota, where the next closest CT scanner might easily be 30 or 40 miles away, this kind of comparison shopping doesn’t even make logistical or economic sense. And if this particular hospital couldn’t tell the patient the price of a basic CT scan or at least take the time to get her the information before going ahead with the procedure, then health care providers themselves are partly responsible for some of the barriers.

No one can argue that the current system is sustainable. It’s not. But the public will have to be far more informed and involved if Minnesota’s health care reform efforts are to be even halfway successful. The question of how patients are supposed to navigate this will have to be a much greater part of the discussion. And that’s the 800-pound gorilla that no one has really confronted yet.

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