An article published in the New England Journal of Medicine examines the dilemma for American physicians as they face mounting pressures to provide high-quality but cost-effective care.
Author Victor R. Fuchs, PhD, said two main drivers have left physicians in a difficult spot: a flood of new, expensive medical technologies and the prevalence of health insurance, private or public, which now pays 90 percent of the country’s healthcare bill. If insurance were less widespread, Dr. Fuchs thinks many physicians would be more reluctant to order expensive interventions unless it offered a good chance of substantial benefit (i.e. cost-effective).
Dr. Fuchs also asked what level of imaging utilization or surgical procedures can be deemed “appropriate,” and said eliminating unnecessary care would only result in small potential savings. Furthermore, physicians may not feel comfortable ruling out certain services due to cost, as “it is often difficult or impossible to determine in advance which ones will prove to help particular patients and which will turn out to have been unnecessary,” according to the report.
Dr. Fuchs said physicians practicing in settings that have accepted responsibility for the health of a defined population, in an organization that receives an annual fee per enrollee, will help physicians provide more cost-effective care.
Read the New England Journal of Medicine report on physicians, healthcare costs and quality care.
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