Health care policy experts versus the public, an obstacle to reform

I’ve often written that the public’s appetite for excessive medical testing is difficult to overcome.

Kent Bottles finds the same thing. Indeed, he writes that, ” One of the obstacles to achieving health care reform is the enormous gap between what the health care experts believe and what the general public believe about staying healthy.”

For instance, according to the Kaiser Family Foundation, “the experts believe that 30% of care is unnecessary; 67% of Americans don’t get the tests and treatments they believe they need,” and, “55% of Americans say insurers should pay even if their doctor recommends a treatment that has not been proven to be more effective than a cheaper one.”

The myth that more testing definitively equates to better medicine is difficult to overcome. Despite the attention showered on the Dartmouth Atlas studies, which often suggest that overtesting leads to poorer outcomes, that doesn’t resonate with the public.

Until reformers can find some what to effectively convey that message, costs will be difficult to tackle effectively.

(via Schwitzer)

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  • http://webseitz.fluxent.com/wiki Bill Seitz

    The first step is to stop hiding costs behind employers.

  • MatthewBowdish

    >Until reformers can find some what to
    >effectively convey that message, costs
    >will be difficult to tackle effectively

    It seems to me that a successful way of conveying that message would be to make medical care more personal, not less. Consumer driven healthcare plans (CDHs) cut costs by 12-21% over traditional insurance plans, don’t sacrifice preventative medicine and lead to greater compliance with evidence-based practices. I would argue that CDHs also allow the patient (with help from their physician) to decide what tests are really important/necessary, as well as invest the patients in their own health maintenance in way third-party payers cannot.

  • Doc99

    Healthcare Experts didn’t put the IRS into HR 3200. Had the Wonks written that bill, it would have been 75 pages at most of clarity. HR 3200 is failing because it’s 1000 pages of such byzantine complexity that lawyers can’t understand it. No wonder Americans are fed up.

  • http://www.epmonthly.com/whitecoat WhiteCoat

    Actually, the cure for those who demand unnecessary testing is quite obvious: Make them pay for it.
    You want to have an EKG done every day? No problem. I’ll give you a Dunkin’ Donuts-type discount card – buy a dozen EKGs, get the thirteenth one free.
    Want repeated stress testing done “just to make sure” that there’s nothing wrong? Be here at 9AM tomorrow with a cashier’s check. Oh, yeah, and the interpretation will be extra.
    Want an x-ray for your obviously unbroken ankle? We’ll treat you the same way whether or not it is broken, but you can still get the x-ray. By the way, we take Visa.
    By shifting responsibility for payment to the consumers who demand the services, the paradigm shifts instantaneously. Suddenly patients start seeking physicians’ advice on what is really *necessary* in order to diagnose a problem, not on what the latest and greatest tests there are to order.
    I frequently see these sentiments already in my practice with patients who have no insurance. So before anyone criticizes my ideas, I encourage you to have some real-world proof of why they wouldn’t work.

  • ray

    there should be some skin for the consumers, until then it will be impossible. System is too opaque currently and people shop better for their sofa and laptops. Doctors should be incentivised to do the optimal thing not “whatever you wish i will do”, gradually doctors and consumers will adjust to this culture. We should start somewhere.

  • Erik

    I have to agree with White Coat. Let the pt’s insurance cover what the doctors deem to be appropriate care. If some docs are idiots, let the peer review/licensing/priviliging system take care of that problem.

    If patients want more care that their doctors think is not appropriate, let them buy it.

    Would change things dramatically in short time.

  • Rezmed09

    Yep.
    Pay 50% of the cost of a normal cath.
    Pay 50% of the cost of ER visits that are not life/limb threatening.
    Pay 50% of the cost of repeat CT’s of the head .
    Pay 50% for antibiotics that are unnecessary.
    Pay 50% of back xrays.
    How about tort reform with some guts.

    BUT… no one in Washington would be re-elected if any of these things happened.

  • http://richiedonahue@msn.com rich1

    i have been reading this web site for only a breif time but i have a question about an issue that i read in this and other places on health care change. in this blog it is “the public’s appetite for excessive medical testing is difficult to overcome” can you actually cite examples of a patients demanding a particular test that is excessive?
    over and over i read this reference,that the public is demanding excessive testing. who is in charge here? i know it goes without saying that an idividual should take charge of their own health but to say they are demanding excessive testing doesn’t explain the role of the physician who is taking orders from a patient. who are these physicians that allow a patient to decide what medical procedure is appropiate?
    i do not know of any physician i.e. a physician who is affiliated in a practice that is peer rewiewed, that could get away with a patient being the one who demanded the test. most responsible physicians know how to say no and say it in a diplomatic way if necessary.
    if the patient makes a demand or most likely, a request, that is not appropriate it’s the physicians resposibility to explain why, not just an abrupt dismissal or a condesending no, but an explanation why the patient is wrong.
    i think in my own opinion, that too many patients leave the doctors office feeling hurt or demeaned by not getting an explanation communicated to them in a language that they understand rather than a language that inhibits them to say “i don’t understand”. instead the hurt becomes hate and they doctor shop.
    i would be careful when i say “the patient demands” because it implies a physician who is inept to speak the truth. or, does it imply a physician who see’s an opportunity to earn a few dollars more?
    until the folks who speak about health care reform include themselves in the proposals they speak of instead of refering to the”public” or with any other term that separates themselves from the maddening crowd, until they come down from their high horse and stop being elitest about health care for them but not us, there will never be public support of change.
    marie antoinette would be proud of this debate.
    the public perception of health care reform is that the reformers have taken care of themselves and the public can have the crumbs left over. that is what is going on with the public and the public is right on the money.

  • Harry

    I really don’t know how anyone can oppose public health care?Are they all brain death or just brainwashed.

    I can understand that a large society, related to health care seeks profits. But if health care is about making money then where will the greed end?

    How can we, as a leading society, promotes the ideals of a democracy and the free world with equal chances, let there own people die because they are not able pay for health care?

    Simple:
    Would let your parents die when in medical need while you prefer to go on vacation? So you don’t need to help?

    This is a moral Issue! NOT ABOUT PROFIT OR FINANCING! It is a OBLIGATION for this great nation to protect there citizen against health issues and illness and if needed to provide medical care!
    Just as the government protect you against terror, rape and crime!.
    Or? – maybe the FBI CIA or HOMELAND Security should become a profit center as well just like health care?
    Shareholder should think about to profit from your security?
    Imagine who would hire the criminals to attract you to pay more for protection insurance? I leave this thought to your imagination.

    “who can’t pay should get eventually killed?”

    Just compare this similarities:
    It really makes me think…

    HEALTHCARE FOR EVERYONE.
    there is no other option!
    This was the promise in the past election !
    That’s what we and the majority of the country voted for.

    Harry
    I couldn’t help it
    had to comment on this