Today’s Managing Health Care Costs Number is 3:1
We talk a lot about value based purchasing. We want to pay providers for “value not volume,” and we want to design health plan coverage so that there is more out of pocket payment for low value services, and less out of pocket costs for high value services.
What about value based policy-making?
Austin Frakt has an NYT Upshot column this week on why drug addiction treatment programs are an economic boon.
Researchers with the Centers for Disease Control and Prevention recently estimated that prescription opioid abuse, dependence and overdoses cost the public sector $23 billion a year, with a third of that attributable to crime. An additional $55 billion per year reflects private-sector costs attributable to productivity losses and health care expenses.
About 80,000 Americans are incarcerated for opioid-related crimes alone. The total annual economic burden of all substance use disorders — not just those involving opioids — is in the hundreds of billions of dollars.
Frakt concludes that each dollar spent on drug treatment saves $3 in other services. That’s a great value. We should be expanding drug addiction treatment.
On the other hand, many (Republican-led) states are rushing to start drug testing on Medicaid recipients. This is a bad idea because Medicaid pays for much of the drug abuse treatment in the US – so depriving people of their coverage if they have a drug abuse problem is Kafkaesque. But let’s stick to value based purchasing.
According to Think Progress:
…The seven states with existing programs — Arizona, Kansas, Mississippi, Missouri, Oklahoma, Tennessee, and Utah — are spending hundreds of thousands of dollars to ferret out very few drug users. The statistics show that applicants actually test positive at a lower rate than the drug use of the general population. The national drug use rate is 9.4%.. In these states, however, the rate of positive drug tests to total welfare applicants ranges from 0.002 percent to 8.3 percent, but all except one have a rate below 1 percent. Meanwhile, they’ve collectively spent nearly $1 million on the effort, and millions more may have to be spent in coming years.
Here’s a commentary from Time Magazineon the topic as well
So – we could spend millions of dollars on drug tests, add extra bureaucracy and stigma, and kick a few people off Medicaid and thus make it less likely they would be able to return to the workforce. That is a low-value public policy if ever there was one.
So – even if we can’t agree to VALUES-based public policy – can we at least agree to VALUE based public policy? If we want to lower our spending on health care, we have to stop promoting low value care as well as low-value public policy.
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