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| Thought Leaders: Medicine |
Heal Thyself
Maggie Mahar
02/01/2007
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To many employers, “consumer-driven health care” sounds like the answer to their
health care prayers. Give employees some skin in the game in the form of a
high-deductible plan that requires that they pay, say, the first $2,000 of their
medical bills, and these employees will be motivated to make sure that they are
getting the best value for their dollars—quality care at a reasonable
price.
 There is just one catch: Patients already have skin in the game—their
own. And if they could, they would dearly love to protect that skin by making
sure they are getting the best possible care. No one wants an unnecessary
angioplasty, a sloppy colonoscopy or daily doses of an expensive drug that has
not been fully tested—no matter who is paying.
The problem is this: Patients
have no way of accurately determining whether the care they get is quality or
not. Consequently, they still make bad medical choices, and employers never
realize savings on the benefit plans they manage.
The myth that consumers are
in a position to oversee their doctors was dealt a blow by a study of 236
elderly patients in two HMOs that was published in the February 2006 issue of
Annals of Internal Medicine. When patients were asked to rate the quality of
their care, they gave their caregivers an average score of 8.9 out of 10. That
score seems fine, except that when researchers looked at the patients’ records
and checked to see whether the HMOs were meeting generally accepted treatment
guidelines, they determined that, on average, the score should have been 5.5.
Diabetics were not being screened properly; patients diagnosed with acute
myocardial infarction had not received aspirin within an hour.
Moreover, the
patients receiving the worst care were just as likely to give their provider a
10 as those receiving the best treatment. The patient’s perception of quality
tended to depend heavily on the physician’s communications skills. Did he appear
to be listening? Did he speak confidently and clearly? These were the qualities
that won high grades—even if the doctor was negligent.
Similarly, patients
are likely to judge a hospital by its service rather than its science. As one
hospital CEO told me: “Patients know if they like the room, the food, the
nurse—but they have no way of knowing if they are getting the best care.” Even
the most sophisticated patient can never be sure if his condition would have
cleared up on its own if he had not had the operation, or if a less expensive
treatment would have served just as well.
Medicine Show
Overtreatment
drives skyrocketing costs. The consensus among medical researchers monitoring
quality is that, today, one out of every three health care dollars is squandered
on unnecessary treatments, unproven procedures and new, overpriced drugs and
devices that are no better than the ones they have replaced.
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