Disease management in the American marketBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7234.563 (Published 26 February 2000) Cite this as: BMJ 2000;320:563
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I have worked with and around the disease management concept in the
US for some seven years now. I've worked with Cardiac Solutions, for
instance. Your article is dead on regarding the measurement of outcomes,
there is very little. We found that Cardiac Solutions did reduce our
particular outcomes in CHF, but cost more, not less, so the program was
dropped. That highlights one of the problems with a free-market system,
costs come before outcomes. However, Cardiac Solutions could have focused
on costs too, but didn't. They didn't have to because it wasn't in their
contract to do so. Quality and Economic efficiency are not, repeat not,
mutually exclusive. It is simply a matter of moving the production (or the
medical ecomnomics equivalent)possibilities curve out by finding efficient
treatment paths, providers, and educating. If you remove the economic
efficiency component, then you will simply pay more for less. Why less?
Why not...? So, the market based system can be the better system in the
long term because firms who will provide better for less will rise to the
top and the others will be selected against.
Competing interests: No competing interests