Fascinating (and extremely long) article on how to change the perverse health care payment system. It focuses on Intermountain - a group of hospitals in Utah making great stride in using empirical date to improve health care and reduce costs.
The most fascinating idea that they discuss is setting defaults. A group of doctors will collect data on some medical issue - like how much medicine to prescribe. They will find what they determine to be the best technique and then set that as the default. The doctor can easily override the default, but to do so, he must consciously decide that the default is not the best option for this patient. A simple procedural change can make a huge difference.
There is, of course, one fundamental requirement. The medical records have to be digitized. The doctors need something to suggest the default position, so the method cannot (yet) be used everywhere. (I should point out that many such procedures do not require computerized records. One example is that every time a patient with heart disease is discharged, a prescription for Beta Blockers is included in the forms the doctor must sign. He doesn’t have to prescribe, but it reminds him to at least think about it).
