No one wants to wonder whether his doctor is giving the best medical advice or withholding better treatment or prescriptions because of cost.
But those questions are likely to start popping up in the minds of patients as pressure mounts for doctors to play not only the role of healer, but also accountant.
Some of the most influential medical groups in the nation – the American Society of Clinical Oncology, the American College of Cardiology and the American Heart Association – are recommending that doctors weigh the costs, not just the effectiveness, of treatments as they make decisions about patient care.
This is another example of the conundrum of high-tech medicine in an atmosphere of limited resources. Arbitrarily limiting medical treatment based on cost is wrong, but there has to be a better solution than putting doctors in the extremely uncomfortable position of determining, based on dollars and cents, the necessary treatments to provide.
The word “necessary” is important here. This isn’t about ordering an unnecessary CT scan or MRI just to avoid getting sued. We’re talking about treatments that are critical to a patient’s well-being, if not life. It is this shift toward forcing doctors to go from worrying about patients to influencing how health care dollars are spent that could have unintended consequences.
As reported in a New York Times story that ran in The News last week, the new guidelines being developed by the medical groups could result in doctors choosing one drug over another for cost considerations or even deciding that a particular end-of-life treatment is too expensive. Some have correctly referred to this practice as a form of health care rationing.
The health care industry should focus instead on reducing potential conflicts of interest that permeate the way health care is delivered, including doctor-owned testing facilities and payments to doctors by the medical industry.
Doctors shouldn’t focus on cost reduction, according to Bruce Boissonnault, president of the Niagara Health Quality Coalition. The right way to reduce costs is by improving quality. Patients don’t want doctors looking for ways to cut corners.
Comparative effectiveness research looks at different therapies scientifically and publicly reports which types of care work best in particular cases. Unfortunately, unlike the British system, it is illegal for federally funded comparative effectiveness research to even consider whether a treatment is more cost-effective. We should not spend hundreds of millions of taxpayer dollars a year on a system that cannot even analyze what types of care provide higher value.
Price transparency should be required at all levels of health care. Because of the Niagara Health Quality Coalition’s first-in-the-nation research publications and exposure, consumers have made major strides nationally in understanding where to find high-quality hospital care. The coalition’s New York State measures have been widely adopted as a national standard of performance measurement.
There are many other ways to improve our health care system and tamp down spending. Burdening doctors with the pressure of having to weigh costs as they make decisions about patient care isn’t one of them.