Cost-effectiveness versus effective costliness.

摘要

In the United States we are sitting at a pivotal point for the future of surgical practice. Political pressures to radically change the way we do surgery are mounting daily as our present health care system begins to collapse under its own weight of costliness and inefficiencies. Cost-effectiveness is the new mantra of the present debates, and few could argue against the concerns expressed about the logarithmic escalation of the cost of medicine in the United States. The complaints are well worn: the United States spends more of its gross national product on health care than any other nation and yet ranks low in the overall health of its population. Up to 56% of our health care costs are spent in bureaucratic management costs by hospitals, insurance, and practitioners who are forced to maintain a massive infrastructure to sort out the myriad paperwork required by private (or public-though public tends to be simpler) insurers or regulatory agencies. Physicians are forced to maintain huge office staffs to deal with authorizations and billing as well as to practice extremes of defensive medicine to avoid potential astronomical law-suits. Hospitals have the same problems, as well as regional market competition and government regulation.