Studies, events show U.S. healthcare is a costly business
Toting up the real cost of U.S. healthcare
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The past few days have brought more evidence of skewed costs and utilization in the American healthcare system. One glimpse came in a study in the Jan. 17 issue of the Annals of Internal Medicine. A committee of the American College of Physicians compiled a list of what it termed commonly overused screening and diagnostic tests.
Health experts are increasingly aware that testing is overdone in this country. Even minor complaints can trigger a cascade of procedures, including radiological scans and exploratory surgery. Not only does this Wild West approach to testing drive up costs, it also puts patients at risk of unnecessary and possibly deleterious treatment because of false alarms.
“Efforts to control expenditures should focus not only on benefits, harms and costs but on the value of diagnostic tests—meaning an assessment of whether a test provides health benefits that are worth the costs or harms,” the ACP report said.
A second study, in the Jan. 23 Archives of Internal Medicine, highlighted another reason behind the explosion of medical costs. Harvard Medical School researchers found referrals from one doctor to another—often a specialist— increased 159% from 1999 to 2009. The probability that a doctor visit would result in a referral increased from 4.8% to 9.3%.
Physicians with an ownership stake in their practices or those who reported that more than half their income came from managed-care contracts posted significantly lower rates of increases in referrals.
Dr. Bruce Landon, one of the researchers, told the New York Times that the growing complexity of medicine has driven the referrals to specialists. But he also cited the “tyranny of the 15-minute visit” with primary-care physicians, who lack the time and resources to delve into complicated conditions.
This isn’t surprising. Slightly more than 40% of U.S. physicians deliver primary care—pretty much the mirror image of primarycare/specialist breakdowns in other advanced nations. The financial incentives here overwhelmingly favor specialists, who sometimes make two or more times what their primary-care colleagues earn.
Despite the flaws, the American health system remains resistant to cost-control efforts. In last week’s issue (Jan. 23, p. 6), we reported on the dismal results of attempts to rein in Medicare spending. The nonpartisan Congressional Budget Office said a study of 10 major demonstration projects in care coordination and value-based payment showed that most did not trim spending. Experts cited several reasons for the failures, including the fact that doctors often don’t talk to each other.
Setting prices may help. One of the programs studied by the CBO made bundled payments to doctors and hospitals for heart bypass surgeries and reduced costs by 10%.
Meanwhile, U.S. costs drew international scrutiny. Canadian freestyle skier Sarah Burke, considered a 2014 Olympic contender, was injured Jan. 10 while training in Park City, Utah, according to news reports. She was flown to the University of Utah’s Health Sciences Center in Salt Lake City, where she died after nine days in a neurological criticalcare unit. Her ski association insurance did not cover the event where she was hurt. News reports that her family might face hundreds of thousands of dollars in medical bills sparked a wave of disbelief and criticism in the media in Canada, where no citizen would be at risk for such steep expenses.
Neither Medicare nor private payers have made a serious dent in U.S. costs in recent years. Don’t be surprised when this country turns to the more rigid price and utilization controls employed in some other nations.