Walter Bradley is the Chairman of the Department of Neurology at the school of Medicine at the University of Miami. Previously on TCHB he wrote a piece on how we should solve the uninsurance problem. Today he takes aim at waste reduction.

R.W.Bush published a paper entitled “Reducing Waste in US Health Care Systems” in the current issue of JAMA (subscription boringly required). In this, he describes the application of the Lean Production methods of Toyota to eliminate waste. In this context, “lean” is “any activity that does not serve the valid requirements of the customer.”  This approach is innovative and he was able to demonstrate that improving efficiency saved money, improved patient care and made the system more “user-friendly.” Waste is undoubtedly one of the elements involved in over-utilization that leads to the high cost of US health care. Others elements that have been suggested to be responsible for the US expending the highest proportion of GDP on health care of all nations in the world  include bureaucracy and administration, malpractice insurance and defensive medicine, and the high cost of goods and salaries of health care workers.

Over-utilization is in part the result of the way that medicine is
practiced in the USA. US physicians are not taught the practice of
cost-effective medicine. Rather the system promotes entrepreneurship.
While this is responsible for the USA leading the world in health care
innovations, it is also responsible for costly over-utilization in the
clinic and hospital.

We need more research to compare medical
practice in the US and other developed countries in order to determine
the most cost-effective ways to care for patients with individual
diseases.

We need to train our doctors to practice cost-effective care.

We
need to develop a center for evaluating comparative effectiveness of
medical care, similar to that recommended by Gail Wilensky, former
administrator of the Health Care Financing Administration.

We need a new approach to the provision of health care in the US
that mandates cost-effectiveness and cost-containment. This could, for
instance, be based on the Massachusetts model of universal coverage, in
which physicians could become stakeholders in reducing the
overutilization and waste that inflate expenditure on health care.