Do patient demands drive up health care costs?

According to recent data from the Pew Internet & American Life Project, upwards of 60 percent of patients first consult the internet for their health issues.

This is leading to more educated patients, taking an increasing role in their own health care. And that’s a good thing. I’d rather be seeing patients who are interested in staying healthy and conscientious about their conditions.

But it’s unfortunate that the incentives within our system don’t encourage these so-called participatory patients.

Having a vibrant discussion with patients, answering their questions, debunking false information found on the web, all takes time. Which is sorely lacking in today’s primary care practice environment. And in this piece from NPR, this time pressure leads doctors to acquiesce to patient demands, more often than not.

Family physician Teresa Moore was interviewed for the piece, and estimates that “30 percent of the costs in her practice are driven by patient requests.” This is an indictment of the system, since doctors like her encourage participatory patients. But the reality is that the crushing burden of paperwork and pre-authorizations are wearing, leading doctors, like her, to “complete paperwork [late into the night] so that she is able to spend enough time with her patients during the day — enough time to explain why this test is probably not necessary, why that pill wouldn’t be a good idea. And her children, she says, pay the price.”

In the end, rather than having a conversation with patients explaining the pros and cons of excessive tests and medications, for instance, the system incentivizes doctors, more often than not, to give patients what they want.

And that drives up health spending.

email

  • weakanddizzy

    This piece is spot on. We talk about protecting patients from bad doctors and medical errors, but who protects the doctors from unreasonable patient and family requests? This is a key issue in driving costs. Until this issue and medical malpractice is addressed I don’t see any chance of real or sustainable progress in improving healthcare ( in both quality and cost terms). My two cents from the trenches.

  • http://www.BookstoreMD.com BookstoreMD

    Patients who search the internet for medical information prior to seeing the doctor are a very prudent group of consumers. They may ask for getting certain tests done which they do not need, due to their lack of clinical acumen. However when explained properly, and logically, about the risks of unnecesssary testing, they usually will be happy to let it go. The key is to explain them the “logic” of why certain tests or treatments are done and others not. And that does take time.

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    Of course, the patients provide fuel for excessive medical care. They, like many of us, worship technology. If patients had some ‘skin in the game’, and had to bear more of the costs of these tests, they would be much more hesitant and discriminating before proceeding. It’s natural for a patient to push for an MRI for back pain when someone else is paying for it. While the public provides the fuel, we physicians are the engine.

  • Michael Barnett

    Kevin – good post, though you will find this article from Dartmouth informative: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731939/?tool=pmcentrez

    The Dartmouth researchers look into the contribution of patient preferences to health care spending and find that they change individual spending, but don’t overall contribute to larger scale, geographic variation in spending. So this isn’t a large part of the bigger puzzle of why we spend as much as we do.

  • patientandchildadvocate

    I think it is a good thing that patients are asking the questions and participating in care decisions and it does take time. The number of patients a provider can see during the day needs to be decreased to allow this important part of care to be included. Physicians should be paid by the hour by clinics or other healthcare facilities and patients given the time they need to get all their questions and concerns addressed. It should be the providers decision to see more patients which might mean overtime – with overtime pay. Wouldn’t it be easier to accept that the salary per hour you make as a provider is the actual hours you put in – even if the hourly ‘wage’ would be less than what you are making now? Physician salaries have room for adjustments – physician should accept that they do not have to (nor should they) be making as much money as they are now. I believe physician incomes have increased more then what is reasonable. Also, working less (or no more that 80 hours a week) is the best thing for your children even if it means less money. That is the real choice here and it is yours to make.

  • http://curbside.posterous.com Nuclear Fire

    @ patientandchildadvocate: Why shouldn’t doctors be allowed to charge whatever they want? This still is a free society isn’t it?

  • christophil, M.D.

    @ patientandchildadvocate – 4 years of college…4 years of medical school…3+years residency…..we are worth it!

  • Doc99

    Patient demands for expensive tests and procedures wane quickly when they learn their third party payor won’t cover them. Then they decide the test truly isn’t indicated. Unfortunately, this works against the patient when the test or procedure truly IS indicated.

  • hawk

    advocate

    Don’t try to influence what I make until you decide to do it yourself. four years college four years med school and three years residency make what we do expensive and worth the cost.

    Not to mention the intangibles. no real income until after residency (i was 35 before i had real income), not getting to see my family due to long hours, working nights and weekends and holidays. not to mention no overtime pay, no sick leave or sick time (I have not had a sick day in 6 years, not one).

    On top of this factor in hostile patients (I want it now or i will SUE you), hostile lawyers, demands from hospital admin. All of the CME (continuing education) board exams, license fees, etc.

    And then realize that I dont get paid for what my time is really worth to begin with (we bill 300 dollars for a visit, if we are lucky we get paid 80). imagine if you called a plumber to your house and his bill was 300, and you only sent him a check for 80. do you think he would be happy?

  • TrenchDoc

    Hawk
    I actually saw a 48 yr old plumber as a patient today who employes 40 people, has offices in 3 states and is a multimillionaire. All because he worked hard and got paid 100 percent of what he charged.

  • Blake

    I have to agree and, as a medical student, toss in to the ring the fact that at the end of 4 years of college, 4 years of medical school, and 3+ years of residency, I will have a nice and shiny $250,000 bank note to pay off over the following decade (or three).

    Also, mid-level practitioners make over $70,000 per year (which I believe they earn and deserve) with only half the education. Without a luring financial incentive while maintaining the burdening legal responsibility, the next generation (my generation) of physicians will simply go to PA school. Or better yet, Wall Street.

    P.S. Don’t we want our best and brightest to go to medical school instead of Wall Street? Why did we stop incentivizing the valedictorians into medicine? What profession would we rather they pursue?

  • Eduardo Alvarado

    Well my dear friends, it is the same in US as it is here in Peru. We are underpaid. Doctors receive a $3/h on night shifts, most only ser family on weekends. We all know that
    medicine is not ONLY vocation for patients, we newsweek incentives as well. I do love practicing medicine, but I love my family the most! We will keep doing the best for patients, but the sysyem should start doing something for us too.

  • http://tanga@hotmail.com andrew tang

    Nuclear Fire

    The problem is that doctors ARE allowed to charge whatever they want, but we are PAID whatever somebody else (medicare, insurance) determines is adequate.

    The charge and actual collection are usually wildly different.

  • http://curbside.posterous.com Nuclear Fire

    @tang: That is if you sign the insurance contracts. Bill the patient directly instead. Accept no insurance. Insurance survives only because doctors accept it.

Trending