Current Issue
Spring 2014
BMM Current Issue
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Assuming Responsibility for Patient’s Pockets
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Doctors know it is not always clear ex ante how helpful a test will be. Nonetheless, many of my colleagues admit to ordering tests on a regular basis that they do not believe will improve patient health. When I asked why, they were quick to offer several reasons. Sometimes they are concerned about seeming negligent and order extra tests to lower their risk of being sued. Sometimes they get the test preemptively to decrease their future workload. Sometimes they are merely complying with their patient’s wishes. But almost all the time, particularly at the point of care, the cost of their decisions is not something that they feel equipped to weigh.

Most doctors are aware, however, that health care costs present a large problem. Despite the historic expansion of health care coverage that was recently signed into law by President Obama, the challenge of reigning in spending remains.

Spending on health care is approximately 16 percent of GDP today, up from 8 percent 20 years ago, and 4 percent 20 years before that. In the near future, Medicare and Medicaid, which contribute half of this spending, will become unsustainable. Investment in other things that matter to us—roads, schools, security—may be crowded out.

And we’re not even getting much bang for our buck. A 2008 Health Affairs report compared health care spending in the U.S. to other countries in the Organization for Economic Cooperation and Development (OECD). Per capita, we spend double the amount everyone else does, but we do not see a return in value. Among the OECD group, the U.S. ranks in the bottom half for most of the measured quality indicators. Meanwhile, medical bills remain the number
one cause of personal bankruptcy in this country.
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great article!
Posted By: MGHdoc
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