Reliance on specialists is driving up the cost of care

November 12, 2006

This observation isn’t new. But with the way that primary care is treated, I don’t expect anything to change soon:

Reviewing a Dartmouth Medical School study that found higher mortality rates in areas that spent the most on Medicare, professor Elliott Fisher concluded that “perhaps a third of medical spending is now devoted to services that don’t appear to improve health or the quality of care “” and may make things worse.” This means that the United States is wasting more than $650 billion a year “” half again more than the entire Defense Department will spend this year, including the cost of the war in Iraq “” on unnecessary and often harmful care.

How can this be? One factor is specialists. Both U.S. and international studies show that the more a health-care system relies on primary care, the better the outcomes and the lower the cost. But American medicine is heavy on specialists and getting heavier. In just the last eight years, the number of graduates of U.S. medical schools choosing careers in family practice and adult primary care has plummeted by more than half.



Related posts:

  1. When specialists provide primary care, and why patients aren’t complaining
  2. Should specialists be re-trained as primary care physicians?
  3. My take: Mid-levels, cost-shifting, IMGs
  4. What’s driving up the cost of health care?
  5. Why primary care doctors shouldn’t be pain specialists
  6. Should primary care distance themselves from specialists?
  7. Males = specialists, females = primary care physicians


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{ 3 comments }

1 Anonymous November 12, 2006 at 7:53 am

So the financial incentives are there from an beaurocratic view, the data is their from a primary care review. So what’s the hold up? Who’s forcing us to remain heavily specialist dependent? Is it the specialists societies and their lobbying? Is it fear of malpractice? Is it primary care playing the efficiency card (easier to consult GI for abd pain than figure it out). If the gov’t would just increase reimbursement for the cognitive specialty, we could find out if the hypothesis is true.

2 Anonymous November 12, 2006 at 12:37 pm

Cognitive specialty? Please. Sometimes I think no cognition is going on anymore in primary care. Refer, refer, refer.

3 Anonymous December 4, 2006 at 2:52 pm

this looks awfully familiar to an article written by john abramson

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