Editor’s Note: Addressing the Health Care Anomaly

One of the biggest burdens on business is the rising
complexity and cost of health care. Every new advance in health care seems to come at a higher price. Its the tax that keeps on growing.

Fortunately, there is an antidote to the disease: transparency. Today, too many decisions are made in the absence of information. Even physicians will admit in surveys that their decisions are based on subjective factors such as personal experience rather than on
scientific evidence. Thats one reason as much as 30 percent of what we spend on health care is wasted on unnecessary procedures.

The Washington Health Alliance, whose membership is made up of large groups of health care users such as Alaska Airlines and Puget Sound Energy; medical systems such as Group Health Cooperative, Providence Health & Services, and UW Medicine; and hospitals such as Virginia Mason and Seattle Childrens, is trying to change all that by collecting data on the quality, cost and variability of care provided in this state.

In January, the alliance released a survey taken in 15 counties of Western Washington to determine the rates at which individuals of different ages and sexes have certain procedures. The survey revealed unusual anomalies. Women between 35 and 44 living in Puyallup are nearly three times as likely to have a hysterectomy as women of the same age range living in Seattle. That surgery can lead to such complications as bladder and bowel injury and excessive bleeding. When it comes to spine fusion, which joins together two or more vertebrae, the survey found that women between 45 and 54 in Olympia were nearly three times more likely to have the surgery than their counterparts in Seattle. This surgery carries the risk of infection, spinal nerve damage that can lead to weakness, pain and loss of sensation, and new problems that may require additional surgery.

The large number of procedures contributes to rising medical costs. A hysterectomy can cost anywhere from $5,100 to $21,000. Spine fusion can cost from $15,000 to $58,000. The alliances survey found statistical variance that suggested overuse of other costly procedures, including sleep testing, CT scans and Caesarean sections. Its unclear what causes the variation in price and surgery rates, but possibilities include physician cultures that encourage certain procedures or spending on costly equipment that must then be paid for through more frequent use.

If we as a state want to lower costs, we must move toward lower prices for procedures and toward practices that reduce unnecessary surgery. Those goals mean doing more such studies. The alliance, for example, plans an expanded study looking at 250 procedures and tests done in regions across the state.

We also need the Washington Legislature to pass legislation requiring insurance companies and hospitals to release all information on medical costs so we can have the complete all-payer claims database so many other states have. Only then can patients and companies make informed decisions about their medical care. House Bill 1437 now before the Legislature is a first step, but it doesnt go far enough.

Using complete information, patients, businesses and insurance companies can seek out quality care that is also the most cost effective. Those decisions, in turn, will drive institutions and doctors to improve their performance. Conventional wisdom says market competition doesnt work when it comes to medicine. Maybe we in Washington can prove otherwise by making available the information the market needs to make efficient decisions.