Instead, doctors Jan Medlock and Alison Galvani argue that “it would be better to concentrate on vaccinating those most likely to spread the virus—both schoolchildren and people between the ages of 30 and 40, who are likely to be the parents of those children, and who are, at the moment, at the bottom of the vaccination priority list.”

I found the model on which they based the research to be of particular interest. While conventional thinking would have approached the study from a micro-physiological perspective, these doctors chose to examine it from the standpoint of economic impact. They used the devastating Spanish flu pandemic of 1918 and the less deadly 1957 flu as case studies to ascertain what “adjusted” death tolls would have been if vaccination standards were different.

With the H1N1 virus purportedly making a comeback in the Fall, we will see how much credence the Center For Disease Control will give to this study. Coincidentally, “the new advice agrees more closely with the recommendations of the CDC’s advisory committee on immunization practices about the best approach to the epidemic of N1H1 swine flu that is now circulating.” Regardless of the official vaccination protocol, experts agree this flu season could be a particularly serious one.

[image via jothenomad]

The article explains the current policy:

“Doctors and hospitals bill insurers for every individual service — every office visit, MRI or hour of operating-room time — a “fee for service” model that drives health-care inflation by rewarding providers who order potentially unnecessary tests, perform potentially unnecessary surgeries and even make mistakes. A hospital readmission caused by avoidable complications just means more billable expenses.”

By contrast, Prometheus utilizes open source software to determine costs based on the care and procedures a patient should receive as opposed to what they did receive – an important distinction. The benefits are twofold: patients are guaranteed a better level of treatment, and healthcare providers are rewarded or penalized accordingly. For example, a doctor that provides both satisfactory care and goes under budget could receive a bonus. In the event that procedures exceed expectations, the doctor would take a financial hit.

In theory, this plan goes a long way to ensure that the system remains honest, the reality is much more complicated. Not to mention that this program forces us to place a lot of faith in a set of equations. And perhaps most importantly, it brings into question the difference between doing what’s right for the patient versus what’s right for the bottom line. And while some estimates place the number of unnecessary procedures as high as 30%, just because doctors might be able to cut back on certain practices, doesn’t mean they should.

Needless to say, this points to the challenges of reforming a system that most agree is broken. Finding a means of holding everyone accountable, while maintaining an exceptional level of care will require compromise, innovation and improved efficiencies.