Wednesday, March 25, 2009

Expensive High-Tech Medicine

By Richard P. Holm MD

In this country the health care system is sick. There are 47 million uninsured people and the number is rising; med students as well as PA and Nurse Practitioner students are choosing fields other than primary care; and the massive numbers of baby-boomers are getting old. Worst of all, we cannot seem to get a handle on the spiraling cost of health care.

Why is it that in this country health care costs are twice as high as the rest of the developed world? Experts explain that it comes from the excessive use of high-tech medicine, which yields only minimal benefit at a very high price.

It seems that much of the spiraling expense comes from excessive and unnecessary use of imaging such as CT scans and MRI; from very high-priced and borderline-helpful types of radiation and chemotherapy for cancer; and from costly techno-heavy procedures that are not proven to significantly improve the patient's condition.

Others have explained that the out-of-control cost of care is due to over-ordering these items since the patient and family expect and demand the latest and greatest, and threaten a lawsuit if the doctor is reluctant, or anything goes wrong.

But alas, insurance companies and the government have tried desperately to get a handle on these costs and have not been able to control the ever-escalating expensive technology. All efforts with preauthorization and oversight have simply not worked.

The solution must begin with patients being financially encouraged to seek proven methods for diagnosis and treatment. Also, everyone must have access to a primary care provider, which means we must find a way to encourage students into this field. Finally the provider must not be pushed by patient, lawsuit, or financial incentive for unproven technology. Value and quality should be the watchwords, and high-tech methods should be used only when it is part of that equation.

The health care system in our country is sick, and the cure should start with a primary care doctor, not with a CT scan.