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Harvard economist: Getting health care coverage for most people is pretty easy

How do you make health care affordable? Remove some of the inefficiencies of delivering and coordinating medical care, which drive up its cost and drive down its quality, Harvard University economics professor David Cutler told an audience of health care providers, administrators and advocates Thursday.

CLEVELAND, Ohio –It’s not difficult to get most Americans health-care coverage. If you make it accessible and affordable most people will buy it, says Harvard University economics professor David Cutler.

How do you make health care affordable? Remove some of the inefficiencies of delivering and coordinating medical care, which drive up its cost and drive down its quality, Cutler told an audience of health care providers, administrators and advocates Thursday at the Cleveland Botanical Gardens.

The audience was assembled to hear about Better Health Greater Cleveland’s third community checkup report — an assessment of the non-profit organization’s progress toward collecting and analyzing care quality measures of how 361 primary care physicians in Northeast Ohio managed the health of their 25,724 diabetic patients.

Cutler, who also was President Barack Obama’s senior health care adviser during his presidential campaign, said his purpose in talking to the group was to be provocative. “What’s the most common occupation in health care?” Cutler asked.

After pausing to let his audience think and respond, Cutler answered: “Office support.” By getting rid of unneeded mid-level administrators, most health systems could be 25 percent more efficient and cut 10 percent from their costs, he said.

The federal government could use the collective savings to provide health coverage for the 50 million uninsured Americans, he said.

Lack of care coordination also is responsible for inefficiencies in the nation’s health system, he said. These inefficiencies show up as too many emergency room visits for minor health problems that needlessly escalate to major illnesses and hospital re-admissions of patients who didn’t understand how to take their medications.

“We’re wasting at least a third of our medical resources” on efficiencies, Cutler said.

How can we deliver health care more efficiently:

  1. Build an information base of medical “best practices.” What practices work best? Which care providers have the best records for quality and outcomes? How can other providers learn from the successes?
  2. Change the way medical care is reimbursed. We need to reward medical value, not medical volume, Cutler says.
  3. Organizational change: Flat organizations are more efficient than hierarchical ones. So are truly paperless organizations that keep electronic information and records.

“I don’t know how to make this happen legislatively,” Cutler said about the ongoing reform efforts in Washington, D.C. But the answer likely lies in a combination of national and local change.

The federal government should be responsible for changes that raise money to provide health coverage for everyone, he said. But it will be local care providers who drive quality improvement and reduce costs.