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Iowa medical care headed in right direction

BY DI EDITORIAL BOARD | APRIL 11, 2012 6:30 AM

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The inflation rate in the United States last year clocked in at around 2.9 percent. To be sure, inflation hawks have worked themselves into a frenzy.

While some inflation might be good for economy as a whole, not all inflation is created equal. The rate of health-care inflation is distressing and demands attention.

Luckily, some Iowa legislators have taken notice, and they are ready to head in the right direction.

An Iowa Senate subcommittee on April 4 — by a 2-1 vote — approved Senate File 2230, which would pave the way for the creation of a health-insurance and cost-containment bureau by Iowa's insurance commissioner.

The creation of the bureau would be accompanied by the creation of an advisory board with seven voting members appointed by governor — largely made up of representatives for consumers, small businesses, and health-care actuaries. Along with these representatives will be seven non-voting advisers consisting of state legislators, the insurance commissioner, and the directors of state human services and public health.

The primary purpose of the bureau and the supporting board would be to streamline data collection and increase the transparency surrounding medical practices. Ideally, by doing this, the Legislature would have access to better information with which to formulate policies concerning medical care, medical insurance, and the provision of both.

Considering the state of medical costs in the country, the timing could not be more appropriate.

The Kaiser Family Foundation reported that compared with the 2.9 percent inflation experienced across the board, health-care cost inflation in the United States last year registered at a whopping 9 percent in 2011.

This rate of inflation is no outlier. In 2008, health-care cost inflation was at 8.36 percent, and it is expected to surpass 8 percent again this year.

Iowa's lawmakers, however, are not the only ones who have taken notice.

There has been a growing consensus among physicians and medical professionals that the U.S. medical-care system is burdened with a large number of unnecessary medical procedures, increasing medical costs. Some do not contribute anything to the health of the patients, while others are wasteful because they could be replaced with less-expensive alternatives that are equally beneficial.

Some, however, are dangerous and risk causing health issues in perfectly healthy people. It has been estimated that these unnecessary, wasteful, and dangerous procedures contribute more than $700 billion in additional medical costs every year.

In response to this, nine specialty groups representing nearly 400,000 physicians in the United States started a new initiative known as Choosing Wisely. Specialists from each field have identified procedures in each of their respective fields they feel cost the system more than they contribute to each individual patient's health. They have identified 45 ineffective procedures.

Among the things they have identified is the over-prescription of antibiotics for sinus infections — the majority of sinus infections are not caused by bacteria; the use of CT scans for children with appendicitis — ultrasounds are cheaper and no less effective; and the use of CT scans and MRIs in cases in which a person has fainted — unless someone has suffered a seizure, these tests are highly unlikely to reveal anything.

Christine Cassel, the chief executive of American Board of Internal Medicine Foundation, the group that sponsors Choosing Wisely, explained the initiative is not saying that these things should never be done, but that they should be used more judiciously.

"We're not saying you should never do these things. We're saying that these are things that are often overused," she said. "So, if you think you need it or your doctor recommends it, raise the question: 'Do I really need this?' "

The American health-care system is riddled with problems in both the provision of care and the provision of insurance. If physicians can admit this, then we and our elected officials can, too.

Luckily, the Iowa Senate is on notice.

The medical-care market is out of control. If the creation of this bureau by the Iowa Legislature facilitates productive intervention, then the public should support the effort, because we will not be able to afford to do nothing for much longer.


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