Consumer Driven Healthcare

[tomz]

With the recent discussions on healthcare in the US fresh in my mind, I found an interesting opinion piece on consumer-driven healthcare.  It is rather long, but very informative.
http://www.thehealthcareblog.com/the_health_care_blog/2006/06/policy_consumer.html

Here's a brief snippet:
"While Consumer Reports can rate mid-priced refrigerators briskly and clearly, in a way that makes comparisons easy, it is all but impossible, even for physicians, to be positive of the relative benefits of a great many medical procedures. The product is opaque; you can’t compare two treatments the way you might compare two cars.  This is not just because the human body is so complex, but because each body is unique—what worked on one patient may not work on another."

 

[Rich_by_the_Bay]

"While Consumer Reports can rate mid-priced refrigerators briskly and clearly, in a way that makes comparisons easy, it is all but impossible, even for physicians, to be positive of the relative benefits of a great many medical procedures. The product is opaque; you can’t compare two treatments the way you might compare two cars.  This is not just because the human body is so complex, but because each body is unique—what worked on one patient may not work on another."

I believe the gist of this to be accurate.

I would add, though, that we could do a much better job of estimating the effectiveness of treatments (and the accuracy of diagnostic tests) if providers were better trained in the fundamentals of "evidence-based medicine." You don't want them relying on drug reps and equipment manufacturers for this stuff ("Gorillastatin reduces heart attacks by 40%. Can your patients affort not to take it?")

These are tools such as learning to assess the quality of research papers, understanding the basics of decision analysis, and really paying attention to patient values and preferences.

And patients can do their part by avoiding demands for unnecessary antibiotics, CT scans, MRIs and other things which -- while wonderful when needed -- often add cost and no value plus, even worse, turn up all kinds of slightly worrisome incidental findings of no consequence, but which generate a second round of expensive tests, etc.

Still, it will remain very tough for patients to judge their doctors like they do refrigerators even with scorecards, "pay for performance" and the like. Throw in a big weighting for interpresonal comfort level, and it's a tall order.

 

[OldAgePensioner]

Rich,
As a physician, I'm sure you see a lot of patients demanding testing but in my case I was thinking of cancelling all my appointments and testing because I felt fine. My original problem was sort of a stroke/seizure/heart attack episode that landed me in emergency. My own self-diagnosis is still extremely low potassium level caused it.

But I felt fine a month later and yet the testing turned up lots of problems. Previous to my health issues, I always thought x-rays, CT and MRI were a scam by the hospitals to make some profit. But I'm now a big fan of testing.

 

[poboy]

I suspect a lawyer or two wishes all these tests were not conducted.

 

[Rich_by_the_Bay]

Rich,
As a physician, I'm sure you see a lot of patients demanding testing but in my case I was thinking of cancelling all my appointments and testing because I felt fine.
But I felt fine a month later and yet the testing turned up lots of problems. Previous to my health issues, I always thought x-rays, CT and MRI were a scam by the hospitals to make some profit. But I'm now a big fan of testing.

Yup, it's entirely individualized.

The key is to assess the pre-test likelihood that the disease your are investigating is actually present. It it is a plausible possibility, a test may be appropriate. If not, the test may add more harm than benefit (recalling that not test is 100% accurate).

So, if a healthy 30 year old comes to me with a routine headache, the benefit of doing a CT scan starts to approach zero, not to mention the cost and risk of false or misleading incidental findings. If her clone presents to me with the exact same symptoms, but has a history of metastatic melanoma (or neurologic findings or exam abnormalities suggesting a brain tumor), that exact same test will have great value. Extreme example, but hope you get where I'm going.

A little judgment, experience and knowledge before deciding to test goes a long way.

So, it's not a matter of being a fan or lots of test, it knowing when they are indicated.

 

[maddythebeagle]

And patients can do their part by avoiding demands for unnecessary antibiotics, CT scans, MRIs and other things which -- while wonderful when needed -- often add cost and no value plus, even worse, turn up all kinds of slightly worrisome incidental findings of no consequence, but which generate a second round of expensive tests, etc.

Nice point. I think this is great reason for people to be responsible for their health care costs to some degree.

 

[OldAgePensioner]

Maddy,
That has been my only concern about "free" health care, some people just can't get enough of going to see the doctor and get tested.

My hypochondriac sister would be visiting emergency rooms every day.