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The public policy blog of the American Enterprise Institute
In a decade or so, according to the Association of American Medical Colleges, the US may find itself needing 130,000 more doctors than medical schools will be producing. Higher demand will come from an aging society and millions more Americans with health insurance thanks to the Affordable Care Act. So are we moving from a health insurance crisis to a healthcare access crisis?
All else equal, perhaps. But all else is rarely equal or static in a dynamic economy like America’s. AEI’s Scott Gottlieb and Ezekiel Emanuel argue that “new technologies are turning the treatment of many medical conditions into less resource-intensive endeavors, requiring fewer doctors to manage each episode of illness.” Also important is having non-physician medical personnel do more. But both innovative solutions could be stymied by government:
The opportunity exists to deliver more services and care with fewer physicians, but it’s not a foregone conclusion. Policy changes will be necessary to reach the full potential of team care. That means expanding the scope of practice laws for nurse practitioners and pharmacists to allow them to provide comprehensive primary care; changing laws inhibiting telemedicine across state lines; and reforming medical malpractice laws that force providers to stick with inefficient practices simply to reduce liability risk. New payment models must reward investments in technologies that can save money in the long run. Most important, we need to change medical school curriculum to provide training in team care to take full advantage of the capabilities of nonphysicians in caring for patients.
As I have written before, I’m a big fan of The Innovator’s Prescription: A Disruptive Solution for Health Care by Clayton Christensen, Jerome Grossman, and Jason Hwang. And what Gottlieb and Emanuel write matches up nicely with a WSJ op-ed from earlier this year where Christensen focuses on two ways to bring disruptive innovation to US healthcare.
– Going beyond current licensing, consider changing many anticompetitive regulations and licensure statutes that practitioners have used to protect their guilds. An example can be found in states like California that have revised statutes to enable highly trained nurses to substitute for anesthesiologists to administer anesthesia for some types of procedures.
– Make fuller use of technology to enable more scalable and customized ways to manage patient populations. These include home care with patient self-monitoring of blood pressure and other indexes, and far more widespread use of “telehealth,” where, for example, photos of a skin condition could be uploaded to a physician. Some leading U.S. hospitals have created such outreach tools that let them deliver care to Europe. Yet they can’t offer this same benefit in adjacent states because of U.S. regulation.
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