Pharmacy and the health cost crisis

Have a colonoscopy performed in some parts of the United States, and it’ll cost you and your health plan as much as $9,000 or more, versus a few hundred dollars in most of the rest of the developed world — even with countries whose healthcare systems are on par with ours in terms of quality rankings and outcomes. The average hip replacement costs $40,364 here, compared with $7,731 in Spain. An MRI scan in the United States runs $1,121, vs. $319 in the Netherlands. And a hospital stay will cost “about triple those in other developed countries, even though they last no longer.”

Those are some of the eye-opening facts cited by reporter Elisabeth Rosenthal in a well-researched story appearing in the New York Times June 1. Under the headline, “The $2.7 Trillion Medical Bill,” Rosenthal paints a grim picture of the way U.S. health costs have ballooned through a combination of factors unique to the United States that have evolved over many decades.

“The United States is far and away the world leader in medical spending, even though numerous studies have concluded that Americans do not get better care,” Rosenthal wrote. For instance, she added, “The high price paid for colonoscopies mostly results not from top-notch patient care, according to interviews with healthcare experts and economists, but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees.”

Rosenthal notes that a lot of attention is paid to the role that expensive tests and “heroic care at the end of life” play in the nation’s high health bills. However, she notes, “a more significant factor in the nation’s $2.7 trillion annual healthcare bill may not be the use of extraordinary services, but the high price tag of ordinary ones.”

That price tag is helping to drive the increasingly desperate search by public and private health plans, employer groups, insurers and patient advocates for cost-saving solutions to the nation’s dangerously out-of-control health cost spiral.

And that search dovetails neatly with the pharmacy profession’s rapid evolution beyond pill dispensing as pharmacists, and the chain and independent pharmacies they work for, present themselves as front-line community health providers and engaged patient-care professionals. It’s about practicing “at the top of your license,” to quote any number of engaged pharmacy leaders, and moving firmly into the realm of clinical care and collaborative health networks. And it’s happening in the midst of a real crisis in U.S. health care, as the nation grapples with an unsustainable but seemingly unstoppable rise in health costs.

It’s a perfect storm. What will it take to turn the nation’s health delivery network into a sustainable model with a more transparent cost structure and a more realistic, outcomes-based reimbursement system? And what role can pharmacy play in that transformation?

As always, your feedback is welcome and appreciated.