Thursday, December 31, 2009

On Implementing A Nonpolitical Health Care Cost Cutting Practice

Norway has managed to pretty much curb the spread of MRSA, Methicillin-resistant Staphylococcus aureus. If the US adopted the Norwegian model, it could potentially reduce the number of MRSA related deaths by 19,000 and reduce health care costs at the same time.

How has it managed to do it? Norway has all but eliminated the wanton prescription of antibiotics for all but the most serious cases that warrant such medications.
Norway's model is surprisingly straightforward.

* Norwegian doctors prescribe fewer antibiotics than any other country, so people do not have a chance to develop resistance to them.
* Patients with MRSA are isolated and medical staff who test positive stay at home.
* Doctors track each case of MRSA by its individual strain, interviewing patients about where they've been and who they've been with, testing anyone who has been in contact with them.

Haug unlocks the dispensary, a small room lined with boxes of pills, bottles of syrups and tubes of ointment. What's here? Medicines considered obsolete in many developed countries. What's not? Some of the newest, most expensive antibiotics, which aren't even registered for use in Norway, "because if we have them here, doctors will use them," he says.

He points to an antibiotic. "If I treated someone with an infection in Spain with this penicillin I would probably be thrown in jail," he says, "and rightly so because it's useless there."

"We don't throw antibiotics at every person with a fever. We tell them to hang on, wait and see, and we give them a Tylenol to feel better," says Haug.

Convenience stores in downtown Oslo are stocked with an amazing and colorful array — 42 different brands at one downtown 7-Eleven — of soothing, but non-medicated, lozenges, sprays and tablets. All workers are paid on days they, or their children, stay home sick. And drug makers aren't allowed to advertise, reducing patient demands for prescription drugs.
So, instead of running to the doctor and demanding antibiotics for every cough and sniffle, Norwegians do without the antibiotics. The same individual in the US usually has a first inclination to demand antibiotics from their doctors, despite that many of those suffering from sniffles and coughs are suffering from viral infections that are untreatable by antibiotics. That increases the costs to the individual and over time adds up for the nation at large.

In adopting the antibiotic methodology, Norway has managed to bring MRSA rates down to less than 1% of staph infections. That compares to 80 percent in Japan (highest in the world), and 63% in the US. MRSA-related costs in the US top $6 billion and while some individual hospitals have adopted methods to reduce MRSA infections, it would take a national rethinking about antibiotics to not only reduce MRSA, but to reduce overall health care costs.

Reducing antibiotic use also has other benefits - it slows the ability of bacteria to gain resistance to the antibiotics, meaning that they can be used for far longer and allows doctors to use them in a more effective manner.

In sum, reducing widespread antibiotic use can:
1) reduce overall health care costs;
2) reduce MRSA-related health care costs;
3) reduce deaths and complications due to MRSA; and
4) improves effectiveness of existing antibiotics to combat illnesses by targeting only those that need antibiotic treatment - extending the usefulness of such drugs;

Who would complain about such things? Well, makers of antibiotics wouldn't necessarily like the fact that their particular drugs aren't getting as much use, but that would be tempered by the fact that most Americans would see their health care costs decline and we'd be healthier for it.

Alas, the government wouldn't exactly be playing a role in how this happens -since it would be up to doctors to reduce their wanton prescription of antibiotics, as well as the reflexive inclination of patients to demand antibiotics for every cough, wheeze, and sneeze.

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