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RomneyCare, HCIT and STEEEP

July 31, 2008
by Joe Bormel
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In today's WSJ (7/31/2008), there's a Letter to the Editor,
At Least RomneyCare Is a Start,” written by Matt Zibell. It’s all about the role of HCIT in the upcoming election. It doesn't say that.

STEEP: It’s helpful, perhaps, to summarize that there is broad, societal agreement that, at a high level, healthcare should be: [ The STEEEP term is in broad use ]

Safe
Transparent/Timely
Effective
Efficient
Equitable
Patient-Centered

Of course, the policy decisions on whether those attributes should be defined by the market (us, as providers, consumers, payers, and others), or by ‘government bureaucracy,’ to stay with the author’s words. If you frame it that way as the author does, the market approach wins. (Actually, the RomneyCare experiment is much more sophisticated than that simplification.)

It’s pretty clear that there are a few other societal issues that drive the equation, including pluralism (we’re Americans, we demand choice; some of us are even Texans, which goes one step farther), entitlement (including very valid pre-existing commitments), and a clear preference for some degree of employer-basis and private economic risk assumption (including insurance).

So, that notwithstanding, when you apply the implications of how HCIT plays into STEEEP, the implications, risks and assumptions diverge rapidly.

Look, for example, at the acquisition and coordination costs of care (seeing your doctor, building out Medical Home, more broadly rolling out VA models, etc). Most of us in HCIT know immediately that the access and communication issues and implications are wildly different. So are the costs.

Is anyone interested in discussing this in the blog? Where is JD Kleinke when you need him?

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Excerpt From Kleinke (2005):
The U.S. health care marketplace’s continuing failure to adopt information technology (IT) is the result of economic problems unique to health care, business strategy problems typical of fragmented industries, and technology standardization problems common to infrastructure development in free-market economies.



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