This has been mentioned in similar discussion here on TOTV.

Here's something I posted from a previous discussion:

If you have time and really want to see where our current health system is headed, listen to lectures and talks on You Tube by Dr. Don Berwick and others at his Institute for Healthcare Improvement. Or read about the overhaul of the healthcare system in Wales or tests of this in places like Oregon. Dr. Berwick was instrumental in this overhaul.

It is called Triple Aim. I personally think some of their ideas are great...with one big downfall. It is ALL controlled by the government and controlled by this think tank geared at saving money and redistributing the government's funds for government controlled healthcare around the world. The Triple Aim is improving the experience of care, improving the health of populations, and reducing per capita costs of health care world wide.

It goes much deeper than just these three things. It is all about changing how the world, not just America, but the world and how we look at and think about healthcare. It is a total overhaul of the current system by changing the current thinking by the pharmaceutical, industry, nurses, doctors, home healthcare workers, attorneys, and most importantly, the patient. It is a savings oriented program. Hospital stays are shortened. From Dr. Berwick's IHI website:

"The Best Care, for the Whole Population, at the Lowest Cost

"The annual cost for healthcare in the United States is about $2.2 trillion with up to 30% of the total health care dollars, or $700 billion, representing care that could be eliminated without reducing quality. Research has shown a wide variation in utilization of certain tests and procedures without differences in quality between high and low utilizing regions. The majority of the variation is not explained by differences in rates of illness, fees, or other population factors. Variation occurs in procedures for which there is often no clear “best option” because of multiple trade-offs between quality of life and risk considerations."

The following is where people get the "rationing" of healthcare. A better way to describe it, IMHO, is to say, for instance, my husband has severe knee pain. Our current thinking in the world is to do whatever is possible to get the best medical care that is available to him.

This isn't fair if some people can afford better care than others. It's like medical science has advanced, but only for people with good health insurance. So, instead, let's start thinking about medicine in a different way.

The goal is to get rid of the pain. Most of the time this means knee replacement. Maybe knee replacement isn't the best thing anymore since everyone can't afford the surgery.

Under this new ideal world Dr. Berwick and others have come up with, we would have a local centered care group talk to my husband about various other options and explain the major drawbacks of a knee replacement; ie costs, need to redo surgery later, pain, rehab time. etc. They will then help him find alternatives to the knee replacement. Cortisone, lose weight, better eating habits, more exercise...etc.

TThe National Priorities Partnership (NPP) of the National Quality Forum has set a series of goals for transformation of healthcare including nine areas where utilization can be reduced without impacting quality. For the prototyping initiative, IHI will focus efforts within two of these nine areas:

Diagnostic procedures: cardiac computed tomography (non-invasive coronary angiography and coronary calcium scoring); lumbar spine MRI prior to conservative therapy, without red flags; uncomplicated chest/thorax CT screening, bone or joint x-ray prior to conservative therapy, without red flags; chest x-ray, preoperative, on admission, or routine monitoring; and endoscopy.
Procedures: spine surgery, percutaneous transluminal coronary angioplasty (PTCA)/Stent, knee/hip replacement, coronary artery bypass graft (CABG), hysterectomy, prostatectomy.

IHI is launching prototyping under the umbrella of our Triple Aim Initiative, and seeks interested and capable organizations to join this effort.

http://www.ihi.org/IHI/Programs/Stra...reServices.htm

If you go to the bottom of the above linked page and go to " Opportunities to Learn More." You can listen to a tele-conference call about a big part of the overhaul plan.

Here is an article about the Triple Aim. You will be hearing more about it in the future. If we don't our children sure will if the world keeps spinning. Note, this isn't a negative scare monger type article. It is a proponent of the plan and just spells it out. It tells how to get the plan implemented in the world.

http://healthaffairs.org/blog/2010/0...he-triple-aim/


How could the United States move toward the Triple Aim? Berwick, and two of his collegues laid out the following steps:

"If we could ever find the political nerve, we strongly suspect that financing and competitive dynamics such as the following, purveyed by governments and payers, would accelerate interest in the Triple Aim and progress toward it: (1) global budget caps on total health care spending for designated populations, (2) measurement of and fixed accountability for the health status and health needs of designated populations, (3) improved standardized measures of care and per capita costs across sites and through time that are transparent, (4) changes in payment such that the financial gains from reduction of per capita costs are shared among those who pay for care and those who can and should invest in further improvements, and (5) changes in professional education accreditation to ensure that clinicians are capable of changing and improving their processes of care."

Let the Health Care Rationing Begin!!

Here's another shorter discussion on TOTV on the subject awhile back:

U.K. looking for ways to "decentralize" their failing National Health Care.

Don't forget the end of life discussions:

Beware the "end of life" discussions with your