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Sat., March 2, 2013

Costly health care system has little bang for its buck

Much has been written about rising health care costs in the United States. A recent Institute of Medicine report finds that the health care system wastes more than $760 billion per year in unnecessary, redundant or ineffective care. That’s appalling. We spend more on health care than any other nation, but rank low in measures of health care quality such as life expectancy and infant mortality. The CIA World Factbook in 2009 ranked the United States 51st in life expectancy and 173rd in infant mortality out of 223 nations. How can we spend more on health care than any other nation but have worse outcomes? A major reason is that more care does not necessarily mean better care.

When buying products or services, we often expect to get higher quality when paying more. In health care, this is not always the case. Having more tests, using the newest medication or having the newest procedure does not guarantee better results. Instead, it may be harmful.

Modern medicine has advanced greatly, but we tend to forget that every treatment and test has associated harms along with benefits. Evidence-based medicine allows a physician to determine what treatment or test will have the best chance of helping a patient. But equally important is using the evidence to decide what not to do. The best health care decisions should be made through meaningful conversations with patients.

Through its statewide campaign – Know Your Choices-Ask Your Doctor – the Washington State Medical Association is educating physicians and giving patients the tools they need to make informed choices about their care, whether it’s avoiding a CT scan for a headache, understanding their choices other than the emergency room when unexpected care is needed, or making informed end-of-life decisions. Through this effort, Washington physicians have teamed up with hospitals, the Puget Sound Health Alliance, county medical societies – including the Spokane County Medical Society – and numerous medical specialty organizations to promote the national Choosing Wisely campaign, an initiative of the American Board of Internal Medicine Foundation. The foundation has asked medical specialty societies to identify tests or treatments with limited value. To date, 25 of these specialty societies have identified more than 130 tests, procedures or therapies that, based on medical evidence, may be unnecessary, harmful or should be discussed with patients before being initiated.

Some highlights include:

• A chest X-ray before surgery may not always be necessary.

• Don’t use imaging tests for minor headaches.

• Don’t use feeding tubes in patients with advanced dementia.

• Don’t automatically use CT scans to evaluate children’s minor head injuries.

• Don’t schedule non-medically indicated inductions of labor or cesarean deliveries before 39 weeks of pregnancy.

Health care advances hold great promise. The ability to transplant hearts and advances in cancer treatment have cured patients who, just a few years ago, would not have survived. But along the way, we have found that some treatments and tests provide little benefit and may actually harm patients.

Governments can’t control health care costs without the help of physicians, and physicians need the help of patients. The physicians of this state are striving to make a difference by educating our co-workers and, more importantly, patients to be better consumers of health care. All of us working together can make a real difference so we can deliver and receive the highest-quality and safest care.

Dr. Brian Seppi is a doctor of internal medicine at Providence Physicians of Spokane and second vice president of the Washington State Medical Association.

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