Paul Dreyer says the key issue today is how to constrain health-care costs. However, he said, “we don’t have a clear understanding of what is driving costs.’’
(Pat Greenhouse/ Globe Staff)
G FORCE | PAUL DREYER
Examining health care
Paul Dreyer says the key issue today is how to constrain health-care costs. However, he said, “we don’t have a clear understanding of what is driving costs.’’
(Pat Greenhouse/ Globe Staff)
Paul Dreyer retired Friday as director of the state’s Bureau of Health Care Safety and Quality, which regulates and inspects hospitals and nursing homes, investigates medical errors, and licenses medical professionals. Except for two years teaching psychology at Bridgewater State College, he has spent his 33-year career with the state Department of Public Health. His boss, commissioner John Auerbach, calls Dreyer smart, energetic, and open to new ideas - like learning snowboarding. Dreyer, 63, recently talked about old and new challenges. Here is the edited interview.
Q. When you started in the Office of State Health Planning in 1976, what was the issue of the day?
A. Health-care costs were increasing at an unsustainable rate.
Q. Sounds familiar.
A. The major cause [then] was an increase in hospital beds. Medicare paid hospitals for days of care so there was no incentive to constrain beds. Then a state health plan created parameters and hospitals had to file plans if they wanted to add beds.
Q. And now?
A. Hospital beds are no longer the issue - the number is less than half what it was when Health Planning began. We’ve come full circle from a highly regulated, centralized planning regime in the mid-’70s through deregulation in the ’80s and ’90s. Now if you look at the landscape in the state and nationally, what you’re seeing is a turn back toward planning and some sort of more explicit approach to cost control.
Q. What was different 30 years ago?
A. No one was spending any time on quality. Clearly over the decades there has been an increasing realization that quality can’t be taken for granted. It requires real work. It was an assumption for a long time that hospitals were providing quality of service.
Q. What about publicly reporting how well hospitals perform?
A. There has been a sea change. Ten to 15 years ago we had very little information about comparative outcomes. Now every week there’s a new public release of data to compare hospitals to their peers.
Q. What’s big now?
A. The key issue today in health care seems to be how to constrain costs. My own sense is we don’t have a clear understanding of what is driving costs. Our efforts to constrain costs will only be successful if they match what’s causing our costs to be so high.
Q. What will you do now?
A. These are issues I won’t suddenly cease being interested in. I told the commissioner I would consult as much as is allowed. I have a major interest in music. I play the clarinet in classical chamber music. I’m trying to learn how to snowboard, and I’ve got three vacations lined up: Las Vegas, a country inn in New Hampshire, and Paris.
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