Experts: too much care pushes health costs up

By Anita Kissée KATU News and KATU.com Staff Published: Sep 22, 2009 at 12:22 AM PST
Experts: too much care pushes health costs up »Play Video

The United States will spend $2.5 trillion this year on health care, according to government estimates, and one reason costs are skyrocketing is because some patients receive too much care, local health experts said.

The reason: "I do too many tests because I'm afraid of being sued," said Dr. Paul Hochfeld, Corvallis Emergency Room Physician.

Corvallis ENT, Dr. Nick Benton, said tests used to be used to rule things out, not to diagnose. Now, he said, physicians practice what is called "defensive medicine" to limit their liability.

"You think maybe that headache is more than a migraine," said Benton. "So, I should get the MRI even though you know it's a tiny chance. We're not really willing to accept less than perfection, certainly not from a malpractice standpoint, so yeah, you get the test."

Hochfeld said patients routinely come in seeking more treatment than they really need, like one patient with neck pain.

"Reasonably the appropriate treatment would be to give her some pain medicine, have her follow up with her doctor, and if she wasn't better in a week or two, get an imaging study," he said. "But she got very angry with me.  Hostile. And I just rolled over and said, 'OK, get an MRI.'"

Over-testing and treatment like that costs between $200 billion and $500 billion a year, according to PricewaterhouseCoopers’ Health Research Institute and Darmouth Atlas on Health Care.

"Someone will have a test done that maybe shouldn't have been done," said Hochfeld. "On an MRI, you'll see something that is questionable. They end up having a procedure done with complications. Then it turns out it wasn't anything that should have been done to begin with."

Carolee Allen is an exception, however. When a mammogram and ultrasound came back negative, her doctor at Kaiser Permanente normally would have stopped there. But she sent Allen to a surgeon for a biopsy, which revealed a rare form of aggressive breast cancer.

"I have a lot to thank Dr. Ginsberg for because she just could have said, 'no, it's negative, that's it,'" said Allen.

Health economist Mark Hornbrook at Kaiser's Center for Health Research said part of the problem is that patients aren't connected to the actual cost because despite rising health insurance premiums, patients now pay far less out of pocket.

"If it's your patient, or your loved one, or yourself - as long as you have health insurance you want the best because you're not paying the full price," he said. In essence, "We have a system that creates incentives for more use."

There could be, however, another motivation. Medicine after all is a business.

"One of the reasons I believe physicians have been so quiet in this health care debate is that specialists, some of them, are doing pretty darn well, and they know fixing health care means they're going to have to make less money," said Hochfeld.

Some argue if doctors are paid set salaries, rather than reimbursed by visit and treatment, they might be more concerned with quality rather than quantity. But these doctors argue for rationing of technology, which is setting limits to technology like MRIs, CAT Scans, and PET Scans (study).

"It's up to society to say, 'listen, we're doing you a favor. We know it's doing more harm than good.' So, if you want to have all this stuff checked, fine, maybe you're going to have to pay for it," said Benton. "I have not heard anybody say that."

Doctors say a better way to think of "rational" care is by recognizing procedures that are done for no valid scientific reason and then no longer request them.

Hornbrook said doctors can also ask questions like, "Is this the kind of patient that would really benefit from MRI or would this go away in two weeks?"

Patients can also ask questions and do research to determine the necessity of the procedure.

According to various research, a patient who is well-informed about the risks and benefits of a procedure, makes better and less expensive choices.

Links to research and sources used for this story: