Friday, November 6, 2009

Thanks, I'd Rather Not (Have That Cardiac Cath)

For any of you interested in health care, I'm going to go a little off message here at family-oriented 500Jerk and point to a New Yorker article offering one explanation why U.S. health care costs are so high. This very readable article about a small Texas border town where Medicare per capita spending is the highest in the country posits that over-utilization likely is a cause of our ever-escalating national health care costs, with "over-utilization" meaning the ordering of medically unnecessary items and services.

In a system where doctors are paid for each test and procedure ordered, and where some physicians even have hospital ownership stakes, the temptation to order additional services can be, well, financially irresistible. If, for example, a physician makes $100 every time a patient has an in-office ultrasound, patients can come to be regarded as profit centers rather than human beings whose overall health is at stake. And although you might think that a little extra health care never killed anyone, you'd be wrong. Ordering unnecessary tests and procedures isn't just affecting our national bottom line--unnecessary tests and procedures actually harm patients in the form of infections, complications, recuperation times, lost productivity, etc. Plus, on a more personal level, I know that languishing in double-booked medical offices is bad for my sanity.

I very much like the building-a-house analogy used in the article to point out how paying per test/procedure doesn't get us where we want to be:

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later?

After reading the article, you may think twice about why your physician is recommending a procedure or insists on an office visit when a three-minute telephone call could answer your question. Maybe it's for your health. But I'm sorry to say that, under the current system, it could also be that the procedure or visit benefits the physician's bottom line.

1 comment:

AppyLove said...

Thanks for posting this article. We've been really interested in this facet of the health care debate and I've heard several really great stories on hospitals with salaried physicians and how they work as opposed to the more standard productivity/procedure-rate model.