I remember reading the Gawande's New Yorker article on how doctors in McAllen grossly overtreat their patients by ordering unnecessary tests and procedures. The McAllen doctors defended their practice by saying that the tests were necessary for thoroughness and preventing malpractice lawsuits. Critics accused the doctors of playing the system for financial gain.
A new study adds an interesting twist to the story. Apparently McAllen doctors only ordered more tests / procedures for Medicare patients (as compared to the avg Medicare spending in other cities) but not patients with private healthcare. Meaning? The doctors are targeting patients with Medicare to "overtreat". Some explanations for this may be that private insurers enforce stricter standards and oversight when it comes to paying for medical procedures, while Medicare dispenses money more freely. Also, I think that regulation also comes at the level of the patient: a Medicare patient has no reason to deny more tests if he/she is not paying for any of it anyway, while a private insurance patient, who probably has to shell out money for co-pays and deductibles, will limit overzealous procedure-prescribing doctors because he/she will actually have to pay for a portion of treatment.
Does socialized medicine lead to overtreating and subsequently overspending? That would be disastrous for the Obama Administration.
All I know is that fee-for-service is not working, and an alternative payment scheme for doctors is much needed.
4 comments:
So since I started precepting, I noticed that at least 50% of the population we see in our clinic is on medicare. They're usually coming in with a handful of complaints and have to deal with chronic ____ fill in the blank ___ and are on 10 medications. (You really don't need to go into geriatrics to treat this population!)
So many of them started doing more and going to more specialists after they started medicare because they just couldn't afford to pay the copay or to pay for the procedure beforehand. I'm scared for the day medicare runs out.
Agreed. This is not a pretty situation.
How stringent should a conscientious patient be about saying no to services that might be unnecessary? I skipped an x-ray on an injured hand months ago because the PA was ambivalent over whether bones might be broken. Is that a reasonable response, or would the cost of that one x-ray be negligible? (Assuming lots of patients began thinking this way.)
On a personal note, perhaps immaterial to the issue, my hand still hurts sometimes, and I wonder if a) it was broken and b) something more could have been done to prevent long term problems/pain.
I'm sorry to hear about your hand Lindsey! :( How did you injure it?
One xray wouldn't have made much of a difference but the lot of unnecessary xrays that are ordered on a daily basis probably would. I personally don't think a test should be offered to a patient unless its necessary, and that's a call the doctor should make (otherwise, why even have doctors? Why not just have procedure dispensing kiosks?) But a patient should have the right to refuse even necessary tests/procedures if they so choose (e.g. when I told my dentist I would forgo the $400 mouthguard and face the consequences, whatever they may be, of grinding my teeth in my sleep)
As for you xray Lindsey, it might not have helped all that much. Even if it did show a small fracture the doc most likely would have just told you to rest it and let it heal..but the doc should have told you why it was better to take it or not.
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