What can we do to improve our medical system? The $300 billion question.
By David Martin, President and CEO of VeinInnovations
Whatever side of the political spectrum you fall on and however you feel about Obamacare, a bipartisan accepted fact is that healthcare in America costs too much. In the United States, we spend more money on healthcare per person ($8745 per person in 2012) than any other developed country. Our spending doesn’t translate into enviable outcomes; in fact, ours are among the worst in developed nations.
There’s no way to tackle all the challenges in American healthcare in one article. (Heck, there’s no way to tackle all of it in one book.) The two main issues are what I’ve listed above: the cost and the poor outcomes that cost is buying us. How can we to improve our medical system?
The Institute of Medicine estimates that $300 billion dollars a year, or ten percent of overall annual spending in the US, is spent on unnecessary medical care. Think back to your last doctor’s appointment: do you feel you received care you didn’t need? The answer is likely no. We trust our doctors to do their best and provide the best possible care. Trust is vital to the doctor-patient relationship. And the majority of us can trust that our doctors are providing the care they think is best.
Even so, there are tests and procedures commonly provided when they don’t need to be. Here’s one example.
CT scans & MRIs for a headache
On occasion, people with headaches get so worried about what may be going on in their brains that they request a CT scan or MRI. Is it a headache or a brain tumor or an aneurysm? In a likelyhood, it’s just a headache. To determine if it’s more, the best course of action is a careful review of your medical history and a neurological exam. The CT or MRI is extra and rarely adds value to your care.
A CT or MRI costs hundreds of dollars. It seems a small price to pay for peace of mind, but you and your loved ones will pay more than money. Brain scans are highly detailed – they may catch a harmless twist in a blood vessel that resembles the dreaded aneurysm. A false find like this leads to more tests and costly consultations, not to mention the stress of your uncertainty. (Another factor to consider? A CT scan of the head can deliver a big dose of radiation, somewhere between the equivalent of 15 to 300 chest X-rays.)
Atul Gawande is the insighful author of Being Mortal, and is a surgeon and a professor at Harvard Medical School and the Harvard School of Public Health. He’s a staff writer at The New Yorker, where his latest piece, Overkill, was published. His long-form article inspired the article you’re reading right now. In his article, Gawande makes the case for cutting back on unnecessary care for two compelling reasons: care you don’t need isn’t a benign extra; it exacts a physical cost and a financial cost on the people who receive it.
Gawande provides examples of low or no-value care. One anecdote, about his mother, is an exercise in absurdity and a day wasted. (After fainting in a grocery store, Gawande’s mother is transported 80 miles to a hospital where she was provided care that was not evidence-based – before someone sat and spoke with her, clearing up the fainting episode as a simple lack of food or water.)
The story that follows is tragic. A friend of Gawande’s, Bruce, okayed surgery on his then 82-year old father to reduce the elderly chronic smoker’s risk of stroke. But the doctors failed to tell Bruce was that the “…carotid surgery in a patient like Bruce’s father reduces stroke risk by about one percentage point per year. Therefore, it would take fifteen years before the benefit of the operation would exceed the fifteen-per-cent risk of the operation. And he had a life expectancy far shorter than that—very likely just two or three years. The potential benefits of the procedures were dwarfed by their risks.” Bruce’s father had a stroke during the surgery and did not return to his old self mentally. He had to move into a nursing home, where he lived for nine more months and then died.
Next week, we’ll discuss solutions to the epidemic of unnecessary care. Where does the majority of responsibility for “overkill” fall? Are doctors beholden to patients to prescribe less? Or is it an issue of patient mentality and education? Or neither?