My healthcare costs are already going to skyrocket, but being responsible for 100% of the premiums just isn’t realistic on my salary. I know I’m not the only staffer looking for a job off the Hill, because I knew this was a possibility…
Most of the overall study population opposed a government CER [cost effectiveness research] agency. About 56% of respondents would oppose such an agency . Democrats and Independents were about evenly split on the issue, while a significantly smaller percentage of Republicans would support such an agency (26.9%). Younger respondents, aged 18 to 29 years, were significantly more likely to support an agency (64.7%) than respondents 65 years or older (31.2%). […]
First, we observed a significant increase in the frequency of treatments that are considered discordant with current guidelines, including use of advanced imaging (ie, CT or MRI), referrals to other physicians (presumably for procedures or surgery), and use of narcotics. Second, we also observed a decrease in use of first-line medications, such as NSAIDs or acetaminophen, but no change in referrals to physical therapy. […]
Recent meta-analyses and research of lumbar fusion surgery have not revealed improvement in patient outcomes and demonstrate that these procedures lead to significant adverse consequences, including 5.6% with life-threatening complications and 0.4% mortality….
Our findings also confirm an inappropriate increase in advanced diagnostic imaging that has been seen previously, with use of CT or MRI increasing by 56.9% in our study sample. Six randomized controlled trials have found that imaging in the acute care setting provides neither clinical nor psychological benefit to patients with routine back pain, and multiple prospective studies have found the lack of serious disease in the absence of red-flag symptoms….
This is a trilemna of cost control. Our health care costs too much, no wants wants an outside entity to say no, and systemically, we do too many expensive things that don’t actually help people.
Benefit design of insurance plans is an attempt to say no or at least to say “really, really, think about this some more….” for procedures of minimal medical value. For instance, my health plan does not cover leeching of blood. My personal benefit package also has a variable co-pay for imaging services. Basic services such as X-Ray and ultrasound have a $25 co-pay while MRI, PET, DEXA, CT and other advanced scanning systems have co-pays of $150 for the first five and then $25 after that as the actuaries figure that MRI #6 is probably medically useful by then. But this is a rough and crude steering method as an MRI is perfectly appropriate when initial physical manipulation indicates a high probability of an ACL tear but inappropriate for non-specific back pain complaints.
Finer steering methods of moving people to more cost effective treatments as the first course of action could theoretically work. If an insurance company said that it would only pay for back surgery after fifteen PT visits and anti-inflamatory drugs have been used, that would reduce back surgery. However, since it is saying no, consumers would bitch about faceless bureaucrats wearing Mickey Mouse ties getting between them and their doctors who are effectively practicing folk ways at this time. And the company would lose members to another firm that charges a little more but does not say no.
System reform changes like the Accountable Care Organizations and capitation models where the doctors are strongly encouraged by profit motives to refer patients to higher effectiveness and efficiency treatments may be the only way to get a politically viable means of saying no in place in the United States.