Current Issue
Spring 2014
BMM Current Issue
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Assuming Responsibility for Patientís Pockets
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Multiple surveys of our profession demonstrate that fewer than one in five doctors understands the impact of the decisions they make on what patients pay for care. It is not our fault. For one thing, health care costs are notoriously opaque: the price a patient actually pays for an individual test is different from what their insurance company is charged which is different from what it costs the hospital to provide.

But traditionally costs are not something we are even taught to consider in medical school. If a medical decision does not cause physical harm and has a chance of being effective, our instinct is to go for it. It doesnít help that talking with patients about payment has always been taboo for doctors. Money is not meant to come between a sick patient and doing everything possible. In fact, doing more is equated with being thorough.

Health care is the only arena in our market economy where we routinely contract for services without knowing what the price is or even exactly what we are buying. For good reasons, patients trust doctors to make purchasing decisions for them. But when doctors are looking at menus without prices, it is easy to order filet mignon at every meal.

Granted, few of us would want to withhold tests and treatments that help sick patients get better, even if they are expensive. The problem is that we have fallen down a precipitous slippery slope. The Congressional Budget Office estimates that $700 billion (an amount comparable to our total spending on the Iraq War) is spent each year in the United States on medical tests and procedures that do not measurably improve health outcomes.

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great article!
Posted By: MGHdoc
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