Health costs up because everyone wants to play House

Where are the private incentives for limiting the use of resources like imaging? Where are the private incentives for limiting the use of expensive drugs?

The health cost blame game is taking another spin.

The President blames health insurance profits for rising costs. Insurers, in turn, blame the high cost of technology, saying their profit margins are modest. Colorado wants to blame the lawyers.

The conventional answer, to be presented at HIMSS in Atlanta next week, is that better use of computer technology, collecting the data and acting on what it says, is the way forward.

But data lessons must be reflected in priorities, either public or private, or the money is wasted. Using computers to collect data does not change how you do business. Changing in response to what data tells you does that.

In what was called a "positive report" last week the National Center for Health Statistics, part of the CDC, offered another answer to the cost question, one that squares with anecdotal evidence.

Tests.

The use of CT scans and MRIs tripled from 1996-2006, the study says. There were big rises in prescriptions, in the use of diabetes drugs, and in such things as knee replacements, but that tripling really stood out.

It's not all because of lawyers.

Take my own wife's story. She had trouble breathing last year. There is a family history of COPD, so a battery of tests were done. Drugs were prescribed, which didn't help. Eventually the problem cleared up by itself. We still don't know what happened.

This is fairly typical. The machines are there. There is every incentive in our present system to use them, especially when doctors own pieces of the imaging clinics.

There is a natural tendency on the part of every doctor to find out what's wrong when a patient presents with a problem. Everyone wants to play House.

There is no incentive not to order battery-after-battery of tests, not to try a variety of medicines, even for conditions that are transitory and might clear up on their own.

There was hope in the 1990s that Health Maintenance Organizations (HMOs) would provide this incentive, by questioning the need for tests and medicines. That hope has disappeared, which is clear from the lay-offs at Humana, which now calls itself a health insurer.

In Europe the disincentive is a fixed national budget. Ineffective treatments can't be afforded.

Absent health reform, in which everyone is in the pool, the only solution for health insurers is to raise rates and push more people out of the system, onto programs like Medicaid. Those programs are now falling apart.

Where are the private incentives for limiting the use of resources like imaging? Where are the private incentives for limiting the use of expensive drugs?

The argument is people will just do without, and many do. More do every year, despite that being a false economy.

And the blame game goes around again.

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