Also read my blog on Health Care Costs under Health.
In Depth: Six Reasons To Say No To Your Doctor
When it comes to economic threats to our country, President Obama says nothing even comes close to spiraling health care costs, expected to hit $2.5 trillion this year. Legislators are struggling to come up with health reform plans that cover millions more people without boosting the deficit.
One obvious place that Congress could look for savings: the waste already embedded in the medical system.
Health policy researchers furiously debate how much is wasted on treatments that sometimes don’t make people better. There are no sure numbers because much of modern medicine remains unstudied and unproven, but by every indication the figure is colossal. Health spending is projected to hit 17.6% of gross domestic product this year. In 2008 McKinsey found $650 billion in excess medical costs, even after adjusting for the fact that rich nations spend more of their incomes on health.
In Depth: Six Reasons Say No To Your Doctor
Elliott Fisher and his colleagues at Dartmouth Medical School have shown that medical spending fluctuates wildly from town to town and hospital to hospital, with no measurable improvement in health in the pricey places. They calculate that 20% or more of all costs could be eliminated without harming anyone. It might even save some lives by preventing complications from unnecessary treatments and hospital stays. At least 40% of all specialist visits and 25% of hospitals stays are unnecessary, Fisher estimates. (For more, see: Useless Medicine.)
“We don’t have any sort of system to measure the effectiveness of what we are doing,” says Dartmouth-Hitchcock Medical Center orthopedic surgeon James Weinstein. He showed in 2006 that patients with herniated spinal discs often get better on their own, without the need for back surgery. “For all of the money we spend, we are flying blind.”
Tests and treatments Congress could target if it decides to get serious about controlling health care costs:
Another strand of evidence comes from health researcher Robert Brook at UCLA and the Rand Corp. In the 1980s and early 1990s, he and his colleagues looked at rates of unnecessary surgery for numerous elective procedures. “Across the board, a large percentage of surgery was inappropriate or of questionable value,” he says. Sometimes it was 30% or more. Brook says no federal agency has been interested in funding his proposals to develop a broad set of surgical appropriateness criteria. “You’d think the federal government would make this a priority. But it is politically too hot to handle,” he says.
Wasteful medicine can be profitable. “Every time you isolate a place where we are wasting money and there is something we can do about it, it takes money out of someone’s pocket,” says Wendy Everett, who heads New England Healthcare Institute, a nonprofit research outfit.
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But American consumers share the blame. They often falsely equate fancy tests with high-quality care.
“There is an assumption that more testing is better care,” says Richard Deyo, a back pain expert at Oregon Health & Science University in Portland. People don’t trust their physicians and assume they aren’t doing a good job if they don’t order more tests.”