Is the pub­lic ready?

Modern Healthcare - - OPINIONS LETTERS -

Re: “Fee-for-all,” (Sept. 12, p. 6): The is­sue is not merely trans­parency but what to do with higher physi­cian costs. Since prices for all health­care prod­ucts and ser­vices are higher in the U.S. than in other de­vel­oped coun­tries (ex­cept generic and over-the-counter med­i­ca­tions), the one so­lu­tion com­ing from Congress and other health­care re­form­ers is: Save money by low­er­ing prices. How­ever, decades of re­search stud­ies from this and other coun­tries clearly demon­strate that low­er­ing prices does not lower over­all cost. If fees are re­duced, physi­cians in­crease the vol­ume of ser­vices and level of tech­nol­ogy. But re­duc­ing vol­ume and tech­nol­ogy is ra­tioning—or at least more in­formed use of prod­ucts and ser­vices.

Pol­i­cy­mak­ers need to re­al­ize that although physi­cian pay­ments ac­count for 20% of health­care costs, what we or­der re­sults in 80% of our an­nual health­care bill. Re­form will never oc­cur with­out a sys­temic re­con­struc­tion, align­ing in­cen­tives of all seg­ments of the health­care field and de­liv­er­ing ev­i­dence-based med­i­cal care.

The real ques­tion that re­mains: Is the pub­lic will­ing to ac­cept these changes?

Dr. Joel Shalowitz North­west­ern Univer­sity

Evanston, Ill.

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