Dr. Zeke Emanuel on the costly, unnavigable maze of healthcare

Even to an oncologist, bioethicist and healthcare policy advisor, traversing the healthcare industry is a complex and confusing journey.

In the latest episode of the podcast Only Human, host Mary Harris sat down with Zeke Emanuel, MD, PhD, to talk about prevailing issues in healthcare and what consumers can do to better manage their health and costs.

Dr. Emanuel outlined three key points.

1. Unnecessary medical tests and services cost the U.S. healthcare system billions of dollars each year. While a fee-for-volume reimbursement model incentivizes physicians to order more tests and procedures, "part of the problem is the psychology in America is more testing has to be a good thing," Dr. Emanuel told Ms. Harris. "And I think many of us who are in the system understand that more testing isn't always a good thing. And sometimes it can be a bad thing in that it can lead to additional tests or a lot of worry that was totally misplaced."

Dr. Emanuel said he personally does not get prostate-specific antigen tests because they prevent only a small number of deaths and result in a high number of over diagnoses. However, even though he said he is "staunchly against" the PSA test, Dr. Emanuel said he has had it done twice, basically because he didn't know he would have it done until after he showed up at the physician's office.

Dr. Emanuel isn't a crusader against medical testing. He does believe physicians and consumers alike should be data-driven. Preventive services such as colonoscopies for people over age 50, pap smears for women and immunizations are very valuable for individuals and for society as a whole, he said. Dr. Emanuel recommends consumers use the United States Preventative Task Force as a source to see if tests are medically worthwhile.

2. Incomprehensible medical bills. Another major issue plaguing the U.S. healthcare system is that medical bills are virtually impossible for the average consumer to understand. After Ms. Harris presented Dr. Emanuel with one of her own medical bills, he said, "I have an MD and a PhD and this is all Greek to me too … these are literally incoherent even to well-educated people."

Dr. Emanuel believes simplifying medical bills would help consumers better understand the costs of their healthcare, which, in turn, could motivate people to spend less. 

3. Reference pricing for discretionary procedures. One potential solution that could help incentivize consumers to opt for lower cost care or forego unnecessary procedures altogether is reference pricing for discretionary procedures, which has been tried in California, Dr. Emanuel said in the podcast.

He described a reference pricing scenario for knee replacement. In this model, the insurer designs a price and then lists a number of facilities that have agreed to do the surgery at that price. If a consumer opts to instead have the surgery at another facility that exceeds the given price, they are responsible for covering the difference.

"That will do two things," said Dr. Emanuel. "First, it'll incentivize you to do a little shopping on a discretionary item. And second, it will send a signal to those hospitals that are charging the high amount, and they will drop their prices."

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