Editorial: Doctors, patients can take action to curb cost

Studies show that up to one-third of U.S. health care spending is unnecessary, but some of the beneficiaries of this inefficiency are actively seeking to curb such waste. Nine major medical societies are calling on their nearly 375,000 members to stop and think before ordering 45 common tests, procedures and medications. The campaign is called Choose Wisely.

Typically, defenders of U.S. health care focus on inputs: abundant technology and machinery, gleaming facilities and armies of specialists. However, from a strict investment viewpoint, we’re getting lousy returns. If we’re going to spend a lot more than other countries – and we do – we ought to demand better results. But America’s rankings on many important factors, such as curing curable diseases, are mediocre.

But before we can control costs and improve outcomes, the system’s financial incentives need to change. Plus, doctors and patients need to take an active role in slowing runaway health care costs.

The first step is to gather and evaluate data on the effectiveness of various treatments. For instance, some regions of the country perform a lot of back surgeries, while others rely more on physical therapy and less aggressive relief. The differences are tied more to tradition than science. Regional variations like this exist on a range of treatments.

Studies have shown that more medical care doesn’t necessarily translate into improved health. Comparatively speaking, the Spokane region is an efficient health care consumer. But Medicare reimburses doctors in heavier-use regions, such as Florida, at a higher rate. This is an obvious incentive to order more tests and procedures.

Our fee-for-service system also does a poor job of paying for diagnoses and coordinating care. As a result, we have a shortage of primary care physicians because the incentives point toward specialization. This, in turn, cripples efforts to ward off surgeries and other expensive treatments in the first place. Other countries reward doctors for keeping patients healthy, not just fixing them.

An eye-popping 5 percent of patients run up 50 percent of health care costs paid by private insurers. One-quarter of Medicare spending occurs in the last six months of patients’ lives, and 20 percent to 30 percent of end-of-life costs yield no health benefits. Advanced-care directives are a remedy to this waste.

Patients also need to become more mindful of their role. Those “ask your doctor” commercials can lead to patients getting medications and tests they don’t really need. Daily health habits, such as controlling weight and diet, can help prevent the chronic conditions that drive up health care costs.

Health care inflation is infecting governmental, business and household budgets. Reforms are bogged down in political and judicial fights. But there are actions doctors and patients can take to help alleviate the pain. It is encouraging to see this sign of recognition from major medical leaders. Now doctors and patients need to heed this advice and choose wisely.