There have been myriad articles of late on the costs of healthcare and reform, yet fewer address the costs of quality. In this guest post, Dr. Seymour Handler, pathologist, provides his insight on cost inflation, “the most important problem facing healthcare in the United States.” He outlines a few key factors in our healthcare system that contribute to this challenge, including:
* Public perception of what medical care can offer,
* The action orientation of Americans, in a more-must-be-better way of thinking, and
* Entrepreneurial zeal.
The most important problem facing healthcare in the United States is cost inflation. What are the basic problems in American healthcare that contribute to cost inflation? The first, possibly the most difficult to correct, may be the public perception of what medical care can offer. We have convinced the public that medical care in the United States is capable of miracles. Contributing to the misconception are the print and visual media. We are regularly bombarded by media claims that there are no limits to what medical care can accomplish. The 6 o’clock television news describes “amazing advances,” “sensational cures,” “major breakthroughs,” etc. The public believes that there is no limit to the value of medical care and research, that care is worth any cost. Many of the “breakthroughs” are in basic science, the fruits of which will not be available for decades. And yet the media exposés imply that they will be available next week.
Further contributing to the excesses of medical care is the action orientation of Americans – bigger, better, faster. Action is a byword; inaction is less acceptable or frowned upon. All physicians have received feedback from typical patient visits, resulting in the following conversation of the patient with friends or family: “He only examined and talked to me. He didn’t do anything – no tests, etc.” The implication is that “doing something” is preferable. Unfortunately, most or many medical conditions are self-limited. With a bit of patience, “tincture of time” if you will, the disorder goes away without any therapy and at no expense. If the physician is “activist” and curries favor with the patient, he tests and prescribes, taking credit for “curing” a self-limited condition. The preferred care adage should be: “Don’t just do something. Stand there.”
An additional complementary factor in healthcare cost inflation is entrepreneurial zeal, particularly prominent in certain medical specialties. In recent years, the greatest contributor to healthcare cost inflation has been radiologic imaging procedures. I am continuously amazed at the ability of radiologists and radiology equipment manufacturers to introduce new diagnostic imaging techniques without prior evaluation of the yield of the procedures as compared to older, less expensive methods. The new procedures have finite yield in particular circumstances. Unfortunately, their availability alone leads to increased utilization in conditions that would do equally as well with far less elaborate techniques. The patient seen in the emergency room for a headache or abdominal discomfort invariably receives a CT scan. Contributing to the excessive utilization of sophisticated imaging is the proliferation of free-standing imaging centers where any semblance of utilization review or indications tends to be lacking.
All of the above are general contributing factors for cost inflation, most of which come under the heading of unrealistic public expectations. In addition to the latter, physicians contribute to cost inflation because of inherent deficiencies in the practice of medicine, particularly a widespread tendency to do too much. As we have discussed, more medical care is not better medical care.
This blog originally appeared at Action for Better Healthcare.