Comments on: Reader take: Moral hazard, and whether patients should consider cost in their health care decisions

By: Doc Stone

Doc Stone — Sun, 05 Jul 2009 16:26:01 +0000

Terry:

Who is going to legislate, fund, and appoint your “healthcare federal reserve”? God? If not, it will be politicians. There is absolutely nothing in my experience on this planet that would lead me to the slightest hope that it’s decisions will not be based on political considerations, or overridden for political reasons. Is there in yours?

By: Terry

Terry — Sat, 04 Jul 2009 07:48:44 +0000

I agree that there needs to be a link between clinical efficacy and reimbursement at some level. At the moment these kinds of considerations are not incentivised.

The Obama administration is supposedly a great believer in evidence based medicine. Hence the comparitive effectiveness research funding in the stimulus (that republicans ensured cannot be linked to payment decisions!)

There are many legislative options (political practicality of course is a different animal)

Eg in France public insurance money will pay 100% for the most effective (and cost effective) treatments, and less and less for more and more speculative treatments. THIS ESTABLISHES THE FLOOR – the minimum of care everyone should recieve. Private insurance and out of pocket payments (moral hazard) pick up the rest of the tab for the more clinically dubious tests/procedures (especially if you have money to spend on really gold plated insurance!). Thus no evil ceiling on expenditure to destroy innovation…

There needs to be a link between efficacy and basic insurance reimbursement in the US. To make that practical and not a red tape nightmare I believe that a single body, like a healthcare federal reserve*, should define efficacy: the “floor”, or the minimum standard that all insurance must cover. These decisions should be based upon cost effectiveness and on the best scientific research available interpreted with physician and scientific community input. They should be updated often as new evidence arises.

If people can afford better coverage then they should be free to buy it!

-terry

* (current financial armagedon notwithstanding)

By: Pattie, RN

Pattie, RN — Thu, 02 Jul 2009 14:40:19 +0000

This guest poster has hit the nail on the head (and futile care in the pocketbook.) If we could make a meaningfull correlation between treatment options and their costs, much useless testing would go away. Of course, that would also include tort reform on malpractice, a “little” item that the Obamessiah doesn’t think is important. We have a brilliant, charismatic, eloquent sociopath in charge of the nation.

By: Tezcan

Tezcan — Wed, 01 Jul 2009 19:10:20 +0000

It is important to know that genetic testing for an established clinical diagnosis can be helpful for genotype-phenotype correlations, meaning the type of the mutation may predict severity and in some cases it may enable participation in clinical trials. For example, if there is a missense mutation rather than a large deletion patient may be eligible for novel drug trials in certain genetic conditions.
Genetic information of disorders continue to be helping scientists understand the defect , protein misfoldings and treatment… I would not dismiss genetic testing that easily

By: Anonymous

Anonymous — Wed, 01 Jul 2009 19:06:58 +0000

It is important to know that genetic testing for an established clinical diagnosis can be helpful for genotype-phenotype correlations, meaning the type of the mutation may predict severity and in some cases it may enable participation in clinical trials. For example, if there is a missense mutation rather than a large deletion patient may be eligible for novel drug trials in certain genetic conditions.
Genetic information of disorders eventually will be very valuable in understanding the defect , protein misfoldings and treatment… I would not dismiss genetic testing that easily

By: cnm3789

cnm3789 — Wed, 01 Jul 2009 18:45:49 +0000

If you want to talk about moral hazard and testing, what about the tens of thousands of obstetric ultrasounds that are done annually with no evidence to support their usefulness?

By: Moral hazard?

Moral hazard? — Wed, 01 Jul 2009 15:36:44 +0000

J They would very much less often choose to pay even for services, period. Medicare may be a social program, but we have all chosen to sacrifice our liberty to do with our income as we will, to pay for Medicare.

Whether a service is of medical benefit is for patient and provider to decide. If a physician orders care that is COMPLETELY FUTILE and has no medical benefit….look to the real source of immorality.

By: J

Wed, 01 Jul 2009 04:28:20 +0000

Re: Kim’s comment. Moral hazard definitely exists, and end-of-life care is one of the best examples. Many in this situation are elderly, and therefore on Medicare. If they, or their families, had to decide to pay for – use their assets, liquidate assets, or borrow money to pay for – they would VERY MUCH LESS OFTEN choose for futile care at the end of life.

By: Moral hazard?

Moral hazard? — Wed, 01 Jul 2009 03:22:40 +0000

So it’s immoral, now, to use privately contracted insurance to cover the costs of treatment? Do you consider the patient is responsible for paying for insurance with his own funds or his labor? That insurance is bought and paid for to cover the costs of medical tests and treatment that are useful to him.

By: Alex

Alex — Wed, 01 Jul 2009 02:50:49 +0000

moral hazard is a perspective not a fact. what about the 10% of patients who did not test positive? from a research perspective, the idea of testing everyone who shows symptoms of the disease means more subjects for a statistical understanding of a disease. perhaps those 10% actually have a related genetic disorder, testing anyone with symptoms of the disease can shed more light on the disease’s genetic origin: more understanding of the gene and the gene product. perhaps there is no moral hazard, the patient could be thinking that testing himself will help scientists understand the disease better in the long run.