Kim talks health care costs, reform options

By Vince Marriott, The Dartmouth Senior Staff

Published on Friday, July 15, 2011

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Policymakers need to focus on cutting health care costs and improving hospital efficiency in order to stop the upward trend of medical fees, College President Jim Yong Kim said to a full-capacity crowd of students and Hanover residents in Moore Theater at the Hopkins Center for the Arts on Thursday. Kim was the third speaker in the summer’s “Leading Voices in Politics and Policy” lecture series.

Kim discussed the balance between slashing costs and main taining every individual’s right to receive quality health care.

“Why is it so difficult to provide quality care for a good price?” Kim asked the audience at the beginning of his presentation.

Kim detailed the skyrocketing costs of basic care in the United States and predicted that health care expenditures would generate half of the nation’s gross domestic product by 2080. The United States currently spends more on health care than all other countries in the Organisation for Economic Co-operation and Development combined, and many company officials are considering eliminating their health care benefit systems. he said.

There is no single solution to this problem, Kim said, adding that he thinks an “interdisciplinary approach” is the best way to change the status quo.

“We need the best thinkers, the best doers and the best communicators,” he said.

Kim explained that the High Value Health Care Collaborative — a group of hospitals from around the country that share data and attempt to standardize care — would play an important role in eliminating the vast differences in quality of care in different regions of the country.

“If these systems join, our collaborative will represent 50 million lives,” he said. “It will be very profound.”

Kim cited the rates of back surgery across the country to illustrate the number of unnecessary medical procedures that occur each day in the United States. While certain hospitals perform about nine surgeries per 1,000 patients per year, Dartmouth-Hitchcock Medical Center only performs 2.3 because of more diligent screening.

“If the entire country performed these surgeries at this rate, we’d save about $580 million a year in health care expenditures,” Kim said.

Health care costs have also increased because many hospitals do not keep accurate records and ignore the total cost of procedures, instead focusing only on their bottom line, Kim added.

“Most health care institutions don’t know their costs,” Kim said. “They know the costs of different components, but not the totals. Most hospital departments are not responsible for keeping to a certain cost, only a certain level of revenue.”

The number of botched procedures and ineffective doctors is also a serious problem, with about 3 percent of all procedures being performed incorrectly, according to Kim.

“Would you fly on a plane if the chance of failure was 3 percent?” Kim asked.

The lack of a system of rating doctors contributes to the inefficiency in health care, he added.

In order to improve this system, policy makers “must redesign care to incorporate pathways of the continuum patient experiences,” Kim said.

Kim pointed to the Dartmouth masters program in health care delivery science as an important step in improving the quality and cost of care in the United States.

When asked his opinion of President Barack Obama’s health care legislation, Kim said he agreed with some aspects of the program, but that he did not think that it places nearly enough emphasis on health care delivery.

He compared the 2010 Patient Protection and Affordable Care Act to former President George W. Bush’s program that provided two million HIV-positive people in Africa with health care. The latter program was an example of a president taking the right initiative in providing care, Kim said.

“Every time bureaucratic red tape got in the way, [Bush] stepped in and made sure the program was running smoothly,” he said.