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| Thought Leaders: Medicine |
Heal Thyself
Maggie Mahar
02/01/2007
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In theory,
health care plans with high deductibles inspire consumers to sniff out value and
avoid unnecessary care. But in practice, surveys show that when cost-sharing
increases, patients are just as likely to skimp on necessary treatments as they
are to skip inappropriate care.
One study, published in June 2006 in the New
England Journal of Medicine, compared Medicare patients suffering from chronic
diseases who had pharmacy benefits capped to similar patients with no caps.
Those with limited coverage were less compliant in taking drugs their doctors
prescribed, had poorer control of their disease, and subsequently had higher
bills for both hospital and emergency care than those without caps on their
pharmacy benefits.
In other words, while in the short run these patients
were spending less, over the long run someone would spend more—and that someone
includes their employers and the taxpayers who fund Medicare. When consumers
make the wrong choices, everyone loses.
By trying to shift decision making to
patients, we are ignoring the real cause behind runaway health care costs. It is
not wanton consumption. By and large, health care inflation is a supply-side
problem. Patients buy what suppliers tell them they need.
Meanwhile, in a
profit-driven system, drug manufacturers, device makers and health care
providers are selling—and sometimes they are selling hard. In our zeal to reduce
health care costs, we cannot expect consumers to guess which treatments are
ineffective or needlessly expensive. Medical professionals—with no financial
interest in the outcome—must set standards for what insurance should cover,
based on the best scientific evidence available. This is not a job for the
patient.
Photograph by Matt Mahurin.
 | Maggie Mahar is the author of Bull! A History of the Boom, 1982–1999 and most
recently, Money-Driven Medicine: The Real Reason Health Care Costs So Much. |
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