Most Americans are under the impression that more health care is better – and that assumption may be killing us.
Americans spend more per person on health care than any other country, and most people believe we are getting our money’s worth. However, a growing body of research is finding that a significant portion of health care provided here is unnecessary, inefficient and, in many cases, is actually harming our health.
Researchers at Dartmouth have found that in parts of America where per person spending is highest, patients are MORE likely to die of heart attacks, hip fractures, and colon cancer. In higher spending areas, patients wait longer for care, have more trouble getting specialty referrals, and have worse inpatient experiences. In fact, more spending on health care is associated with more tests and procedures that aren’t necessary and could cause harm.
This finding is tough to digest when we also know that the health of too many Americans, especially the uninsured and those on public programs like Medicaid, is at risk because they can’t get enough health care.
The truth is that very little of the care doctors and providers recommend is based on clear scientific evidence of its effectiveness or quality standards. Only 11 percent of more than 2,700 recommendations approved by cardiologists for treating heart patients is supported by high-quality science. Other studies found that one third or more of all procedures performed are of questionable benefit, and conversely that some procedures are under-utilized.
For example, only 20 to 30 percent of depressed patients seen in general medical practices were prescribed anti-depressants, and one third of those who got a prescription were given the wrong dose. The use of procedures varied up to three fold between different communities; the variation had nothing to do with differences in age, gender, or incidence of the disease.
An important part of last year’s federal stimulus plan devotes $1.1 billion over ten years to Comparative Effectiveness Research (CER) to sort out which treatments work from those that don’t. New research, for instance has raised questions about the effectiveness of surgery to insert stents into patients with heart disease; there is growing evidence that this common procedure is not appropriate for many patients and carries all the risks of major surgery. Another study found that about half of the millions of patients taking the strongest stomach acid prevention medications do not need them, risking side effects such as infections and bone fractures. CER will be able to distinguish which patients are likely to benefit from a treatment, allowing treatments targeted appropriately to the right patients.
Despite the clear need for information, a new study found that consumers have very little knowledge of comparative effectiveness research and are very skeptical about the benefits. Most believe that all care meets minimum quality standards and that medical guidelines are inflexible, keeping doctors from doing their job, the study found.Consumers worried that guidelines based on research might “discriminate against doctors who give you better care” and the guidelines are just cover for doctors worried about lawsuits. Effectiveness research is confused with rationing and is only designed to deny needed care to save money.
It is true that health care spending is out of control and the current rate of growth is not sustainable. The good news is that with better research we can limit spending and improve the quality of care we all receive.
CER offers one of our best tools to reduce costs, improve quality, and move decision-making power back to patients and their doctors. Clear, reliable information will allow patients and doctors to make better choices, regardless of cost. Patients can decide when a drug, device, surgical procedure, or diagnostic test are worth both the risks and the cost.
Ellen Andrews is Executive Director of the CT Health Policy Project, a non-profit research and advocacy organization working to expand coverage to affordable, quality health care for all Connecticut residents. The Project provides policymakers with information about options for coverage and provides assistance to consumers struggling to access health care in Connecticut.