One of the most difficult costs to grapple with: What is the cost of the fragmented care Americans experience?

It is a huge sum, to be sure. On the ground, it is possible to see it any time you talk to a patient who has been through a major illness.

No one, but no one, has solved the problem of how patient care can be better coordinated.

Last week, in an article in The New England Journal of Medicine, the authors said more than once that the “medical home” concept for patients—one in which patients’ care is coordinated—will be hard for primary care practices to provide. For some specialties examining whether its doctors could provide medical homes, the authors were not optimistic.

A medical home could contribute to managing costs so that dollars are spent on care and not confusion.

However,  it is hard to convey how challenging it is for a medical practice, never mind a nation, to retool its care delivery system while it also delivers care.

The New York Times

“A government analysis of the new health care law says it will not slow the overall growth of health spending because the expansion of insurance and services to 34 million people will offset cost reductions in Medicare and other programs.”

…”But Mr. Foster said, “Overall national health expenditures under the health reform act would increase by a total of $311 billion,” or nine-tenths of 1 percent, compared with the amounts that would otherwise be spent from 2010 to 2019.

“In his report, sent to Congress Thursday night, Mr. Foster said that some provisions of the law, including cutbacks in Medicare payments to health care providers and a tax on high-cost employer-sponsored coverage, would slow the growth of health costs. But he said the savings “would be more than offset through 2019 by the higher health expenditures resulting from the coverage expansions.”

Source: New York Times, April 25, 2010

Citation: New England Journal of Medicine, Online, April 21, 2010