American Physicians: High Costs? Don’t blame me!

America’s health care non-system is the place where the “most informed” believe they have the least responsibility.   It’s everyone else’s fault.  So says the recent JAMA (Journal of the American Medical Association) study Views of US Physicians About Controlling Health Care Costs

A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a “major responsibility” for reducing health care costs, whereas only 36% reported that practicing physicians have “major responsibility.” Most were “very enthusiastic” for “promoting continuity of care” (75%), “expanding access to quality and safety data” (51%), and “limiting access to expensive treatments with little net benefit” (51%) as a means of reducing health care costs. Few expressed enthusiasm for “eliminating fee-for-service payment models” (7%).

Read the article.

Medicynical Note:  The irony is that those who are (used to be) the most informed claim least responsibility for the mess that is our non-system of care.  Physicians have abdicated everything except keeping the current fee system intact.

The questionnaire was a loaded one with obvious “right” answers.  for example

Most physicians reported being “aware of the costs of the tests/treatments [they] recommend” (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they “should be solely devoted to individual patients’ best interests, even if that is expensive” (78%) and that “doctors need to take a more prominent role in limiting use of unnecessary tests” (89%). Most (85%) disagreed that they “should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more.”

The problem is that most of the “new” agents in medical oncology, for example, offer limited benefit, that is, in most cases of advanced disease the treatment will give a month to a few months survival benefit and only occasionally provide longer term survival.  At over $100,000/year the cost of the buying, if you will, an additional year of survival, is in the hundreds of thousands of dollars/QALY.  

It used to be, that such drugs were cheap (5FU) in colon cancer in the 70’s and 80’s.  ($10-15/dose–you read that right)  In such a case you could try the drug anyway you wanted.   If they worked great (about 10% of patient’s responded) if it didn’t you did not bankrupt the patient, insurer or system. 

Someone has to be responsible in the new era of mega-expensive medications.  It’s clear that physicians have punted and that the pharmaceutical industry is only interested in their bottom line.  Insurers simply pass through the costs.  So it’s left to government.


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