A committed cardiologist focuses on prevention, and successfully reduces the incidence of heart attacks. The problem – his practice is losing money:
See, preventive medicine just doesn’t pay in the current American medical system. “The time we spend with patients — we get rewarded almost zilch,” Dr. Agatston says. Or as Dr. Valentin Fuster, a former president of the American Heart Association, puts it: “There is no incentive at all. It’s a disaster.” . . .. . . But a lack of insurance is only one of the two huge problems with health care. The other is the perverse system of incentives that nudges doctors and patients toward expensive tests and procedures when cheaper preventive measures might actually produce better results. Partly as a result, costs are rising rapidly for the 250 million people who do have insurance.
Related posts:
- How the economy may make health care costs soar
- My take: Overcrowding, prevention, digital mammograms
- Would you accept a lower salary if you could graduate from medical school debt free?
- Op-ed: Doctors are forced into running a business
- The cost of “free” healthcare redux
- How the government is banking on prevention to save money
- Does preventive medicine save money or cost more in the long run?
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{ 4 comments }
I have to say, my husband’s heart specialist was happy that he has lost weight, is exercising, and is eating right. When my husband gave me the credit (for keeping his diet right and making him exercise), the doctor asked (jokingly) if I would come and work with them, because they have patients who need motivating.
Maybe I should appreciate the heart specialist more than I have in the past?
The article raises an important point:
“It’s important to note that the economic gains from preventive care are sometimes exaggerated. Sadly, the cheapest patients are often the ones who receive no care whatsoever, because many die before they reach their medically expensive golden years.”
Improving preventive care in this country is important for the nation’s health, but it’s not going to solve the financial problems of our health care system.
So what motivates unnecessary defensive testing more…lawsuit fears or the opportunity to increase revenue?
Not trying to be snide…just wondering if it isn’t a little of both in some cases, perhaps.
Anon 7:24 –
Most (I would estimate 99%) of defensive testing does not profit the physician who is ordering it.
For example, radiologic studies are almost never ordered by the radiologist. Most primary care providers do not own MRI scanners, CT scanners, and fewer than ever own plain x-ray equipment (I used to, but got tired of eating the costs when insurers refused to pay for it). Most emergency room docs do not own nuclear stress test machines, or stakes in cath labs, and similarly do not own shars of CT scanners and MRI machines.
Most of us do not own laboratories (I used to, but again, the inifinitesimal margin made in unacceptable) so ordering blood work does not raise revenue.
When someone is hosp[italized, in most cases, the hospital is payed a flat rate, so they actually lose money when more tests are ordered.
While there are some specialties that can make large profits on testing, they are a minority, and the rest of the defensive testing is just defensive (if notmisguided).
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