RALEIGH – Have you tried a “minute clinic” or urgent-care facility lately? If your perceptions of such medical options are limited to the “doc in a box” stereotype, you might be surprised at the quality of the experience.
During a recent bout with what was eventually diagnosed as bronchitis, I stopped by the CVS Pharmacy Minute Clinic in North Raleigh on the way back from lunch, saw a skilled and caring nurse within five minutes, and five minutes later was headed down the road to an urgent care for x-rays. Not long after that, I had my diagnosis, my prescriptions, and a clear explanation of what to do and what to expect – all at a reasonable price, paid out of my health savings account with a swipe of the card and no insurance claim to fiddle with weeks or months later.
One of the troubling aspects of the current health care debate is that to the extent innovation in medical services is discussed at all, it’s often assumed to be a bad thing – a force that drives up costs without improving the quality of care.
Admittedly, some new medical procedures, devices, and pharmaceuticals do offer only modest benefits, if any. In a more rational system for financing health care, the incentive to save money would be more in line with the ability to make consumer decisions. As a result, fewer such marginal innovations would survive the test of the marketplace. The current approach of billing third parties, either insurers or the government, for medical services of all sorts is what leads to waste – not innovation per se.
Indeed, while the argument that preventive care usually pays for itself in foregone medical costs is questionable, there is good evidence for a somewhat-different argument: that many medical innovations pay for themselves by reducing the need for costlier hospital stays or lengthier treatment regimens.
Some of these net-plus innovations are like minute clinics. They rely on standardizing best practices to save time and money, capturing and using patient information in real time, and substituting lower-cost treatments and providers – such as nurse practitioners and physician’s assistants handling routine wintertime ailments such as cold and flu. (Betty Joyce Nash recently wrote an excellent piece about minute clinics for the Federal Reserve magazine that’s well worth your time.)
Other net-plus innovations involve new inventions, discoveries, and technologies. Ronald Bailey, science correspondent for Reason magazine, writes in the February print edition (not yet online) about a recent study by Columbia University economist Frank Lichtenberg. He looked at state data on the quality of medical care, doctor training, patient, behavior, education, income, and insurance coverage to see what relationships he could find between these variables and life expectancy.
Among other things, Lichtenberg found that technological innovation matters. States that more rapidly adopted new drugs and new diagnostic imaging techniques had bigger gains in life expectancy that did slow-adoption states, after adjusting for the other factors. Between 1991 and 2004, average life expectancy in the U.S. rose by two years. Lichtenberg estimates that about a third of this improvement came from the proliferation of CAT scans, MRIs, and similar diagnostic technologies. Much of the remaining gain came as new drugs entered the market to treat or reduce the risk of life-threatening conditions such as strokes and heart disease.
What didn’t correlate with a state’s gain in life expectancy? The degree to which residents lacked health insurance coverage during the year.
To increase life expectancy is, of course, not necessarily to save money. But in his study of the state-by-state data, Lichtenberg found at the very least technological innovation that improves health does not drive up medical costs. He noted that “while newer diagnostic procedures and drugs are more expensive than their older counterparts, they may reduce the need for costly additional medical treatment.”
Any health care reform worth pursuing should welcome innovation and seek to foster it within a competitive marketplace for medical goods and services. ObamaCare doesn’t pass that test. After due consideration, I’ve concluded that it may not be a good idea.
Hood is president of the John Locke Foundation