Guest columnist
Market-driven medicine

By Donald E. Stevens
Special to The Times

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Carol Ostrom's article "A dilemma for doctors: Who'll get flu vaccine?" (page one, Nov. 23) concerning distribution of available flu vaccine was both timely (I am asking the same questions as to which of 1,000 patients will get the 80 doses of vaccine made available to my practice) and insightful.

While helpful, neither a Centers for Disease Control and Prevention medical-ethicist consensus recommendation or evidence-based medicine algorithms can supplant a physician's judgment and knowledge of his or her patients when it comes to this type of decision.

More important, the article prompts a larger question: How do we address supply and demand in health care? The current shortage of influenza vaccine has, in fact, created a real-time experiment in which both institutions and providers are placed in the position of rationing a health-care resource. Fortunately, by spring, flu season will be behind us, and the "crisis" will be over.

The greater crisis awaits this country as we deal with an increasing demand for a resource that is economically difficult to access for both individuals and employers. I hope in my professional life the inherent waste in health-care delivery, including bloated administrative costs and the antiquated information systems we have relied on, are relegated to the dust bin.

There is hope. Providers need to work smarter through the use of electronic medical records and e-based sharing of patient information. Both are imperative to improving safety, efficiency and cutting costs. Our philosophy of how insurance should function has to change. Consumers need to recognize that insurance is meant to protect against a financial burden that we cannot withstand.

While it is morally and ethically a necessity to take care of those who are without adequate resources, those able should accept first-dollar responsibility for their medical costs by contributing to HSAs (health savings accounts) and purchasing high-deductible insurance. If you control where you buy care, you are more likely to see a market-driven economy resulting in reduced medical costs. Most important, take personal responsibility for your own health. In large part, health is the sum of choices we make individually.

The issues are huge and solutions complex, but bigger doses of the current health-care delivery prescription inevitably will lead to treatment failure. We can't afford a sicker system.

Dr. Donald E. Stevens practices at South Kingston Internal Medicine in Kingston, Kitsap County.