First, not all diseases are equal. This one is pretty obvious, but I'm not even talking about how severe the diseases. That's vitally important of course, but even a "minor" disease can lead to long term impacts to quality of life because we don't know how to treat the disease. In some of these cases it might just be embarrassing, such as if I eat Gluten and I'm out and about the next day. I'll probably have some serious issues and won't be able to enjoy myself while I'm out. There are two reasons for that. One, it's not really obvious what condition I have. Two, there's no treatment to allow me to eat gluten other than "avoid" wheat, barley, and gluten. Which in many cases is rather difficult.
This brings me to the second reason why there's a lot of difficulty - it's difficult to even diagnose what disease people have. So, for gluten issues you have only a few options, one is a blood test to looking for an immune response to a gluten or to have a colonoscopy to see what sort of damage has been done to your large intestines. Because of this lack of precision, in many cases it can lead to the matching the wrong treatment for the right disease, vice versa, or wrong treatment for the wrong disease in the most extreme cases.
|Precision of Diagnosis and Precision of Treatment matrix|
This really puts the model on it's head as the provider can take advantage of the diverse networks they are part of to learn different components of research based on the focus of those providers. I think that a true partnership between insurers and providers really will drive down health costs.
This complexity is unfortunate, but is truly part of our human condition. One way to reduce costs is to increase the amount of research that pushes care into the upper right from the bottom left. Otherwise, it's difficult for an insurer to determine which providers are taking advantage of patients and which ones are honest. There's imperfect information on both sides and the patients pay for it in the long run.