Wiser use of prescription medications by everyone – doctors and their patients – could save the U.S. health care system more than $200 billion a year. That’s the conclusion of a new report, “Avoidable Costs in U.S. Healthcare,” from the IMS Institute for Healthcare Informatics.
Inefficient or ineffective use of medications lead to 6 million hospitalizations, 4 million trips to the emergency room and 78 million visits to doctors and other care providers each year, according to the report. Those are huge numbers.
Although $213 billion represents less than 8 percent of what Americans spend on health care each year, it’s still a staggering sum. It also exacts human costs that aren’t reflected in the estimates.
The report identifies six things that can be improved to address the problem:
1. Not taking medications as directed: Most drugs are prescribed for a good reason. Take antihypertensive medications. They are used to lower blood pressure. Not taking the drug allows blood pressure to remain high, which can lead to a very expensive stroke.
People don’t take medications as prescribed for several reasons. They include fear of drug side effects, not understanding complications that can occur without treatment, and not being able to afford their medicines. The report estimated that taking medications as directed accounted for almost half of the $213 billion in savings.
2. Taking too many medications: This has become a huge problem, especially in older people with multiple medical issues. Doctors often add medications based on new symptoms, but they seldom tell their patients to stop taking drugs prescribed earlier or to take lower doses. The more medications people take, the greater the chances they will experience a harmful interaction between medications.
3. Delayed treatment: Doctors can’t prescribe potentially health-saving medications if they don’t know that patients need it. Better screening for a hidden condition like hepatitis C, for example, could identify those with it and get them started on medication that could prevent costly cirrhosis of the liver, liver cancer, or the need for a liver transplant.
4. Overuse of antibiotics: Far too many doctors still prescribe antibiotics for upper respiratory infections, simple bronchitis and ear infections, even though many of these are caused by viruses, which aren’t affected by antibiotics, and many get better just as fast without an antibiotic. This adds unnecessary costs for the unneeded antibiotics. Use of antibiotics can cause side effects such as severe allergic reactions and diarrhea, which can lead to hospitalization. It can also help create bacteria that are resistant to antibiotics, a growing problem in the United States.
5. Medication errors: Errors occur in different stages of medication use. Doctors sometimes prescribe the wrong drug or dosage. Pharmacists sometimes prepare or dispense the wrong drug or dosage. And sometimes patients take, or are given, the wrong drug or dosage.
6. Underuse of generic medication: Many people are reluctant to take generic medications instead of their brand-name versions, even though generics contain and deliver the same active ingredients as brand names. And many doctors don’t tell their patients about generic alternatives unless the patient asks.
The United States spends more money on health care per person than any other country in the world (17.6 percent of our gross domestic product versus 11.6 percent in France and Germany). But we are far from No. 1 in quality of health care. In fact, among 17 of the leading industrialized nations, the U.S. ranked dead last in life expectancy.
Better use of medications won’t solve our health care spending crisis, but it can help. What would really save us money, and improve our health, is preventing disease with a healthy lifestyle. The biggest bang would come from beginning that in childhood and maintaining it throughout life.
Dr. Howard LeWine is chief editor of Internet Publishing at Harvard Health Publications and a hospitalist at Harvard-affiliated Brigham and Women’s Hospital in Boston.