NPR reported today that “…as much as
one-third of all procedures performed in the United States are of ‘questionable
benefit’” (1). The news agency explained: “These procedures drive up cost and
don’t help patients.”
This is appalling! How can a group
of professionals who have sworn to “do no harm” conscience charging patients
for these tests? On the face of it, this seems like it verges on criminal malpractice.
But actually, I think the fact that doctors are overcharging patients for these
unnecessary procedures is a symptom of a dysfunctional healthcare system. When
doctors have to jack up prices (knowing that patients with insurance will not
end up paying most of that sticker price) to pay for uninsured patients, we
know that there’s a problem.
The good news is that some doctors
are trying to change this norm: “In a move likely to alter treatment standards
in hospitals and doctors’ offices nationwide, a group of nine medical specialty
boards plans to recommend on Wednesday that doctors perform 45 common tests and
procedures less often, and to urge patients to question these services if they
are offered.”
However, there is still much to be
done. And discussion of the healthcare system is particularly relevant now
since the Supreme Court is currently deciding the fate of Obamacare. But no
matter what happens, the most important thing is to change the incentive
structure for doctors: the fee-for-service model that we have now is just not
working, as indicated by all these unnecessary tests. This is where we should
start.
2 comments:
I'm not sure it's entirely a function of doctor's having to cover the cost of insured patients who won't pay the full price - we should reasonably expect the price paid by those with insurance to cover the cost of the treatment. I think that it's more to do with threat of a lawsuit if there turns out to be an issue that one of these tests might have caught. As the NYT article notes, "some of the tests being discouraged — like CT scans for someone who fainted but has no other neurological problems — are largely motivated by concerns over a malpractice lawsuits."
Even disregarding the issue of litigation and overcharging, however, the overabundance of tests may be wrong in and of itself. Sometimes more information can't actually help a patient - maybe a test would indicate a possibility of a condition or a predisposition to an untreatable disease that hasn't yet manifested itself. Overtesting can also lead to other needless (and expensive, and potentially harmful) procedures like removal of benign tumors. What's more, this information might then be used by an insurance provider to the patient's detriment. Kathryn Nix, the health care policy analyst for the Heritage Foundation, comments that "there has been a strong push [by insurance companies] for using this information to limit patients’ ability to make decisions themselves."
I agree that there is a problem with the way that medicine is practiced today, but I'm just not so sure that it's the doctors who are to blame.
While I agree that doctors overcharging patients for unnecessary is a sign of a dysfunctional healthcare system, I think that it is also a sign of larger problems arising from our lawsuit-crazy culture. It may be the case that some doctors earn more by carrying out unnecessary tests, but many doctors are more thorough than necessary with their tests to protect themselves rather than because they are setting out to earn more money. The New York Times article that NPR links to mentions that “Some of the tests being discouraged — like CT scans for someone who fainted but has no other neurological problems — are largely motivated by concerns over a malpractice lawsuits.” If a problem later arises that a common test could have revealed early on, then in many cases, it is the doctor who is seen as responsible. For many, if common tests will protect them from such cases, then they will carry them out. While doctors should work to curb unnecessary tests, we really do have to consider both the motives of profit and protecting against malpractice before we can move forward.
http://healthland.time.com/2012/04/05/physicians-groups-call-for-fewer-tests-for-patients/
http://www.nytimes.com/2010/03/30/health/30use.html
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