In an old but still very good article published in Harvard Business Review (see link below) we learn that inappropriate care wastes $300 billion per year in the US healthcare system.
This fact raises the question: What is inappropriate care?
Answer: When physicians, perhaps with the best intentions, render care to their patients that has little possible chance, based upon known clinical science, to improve the health of the patient, the care is clinically inappropriate. As detailed in the article, the use of antibiotics in the setting of the common cold is a common example of inappropriate care.
Unfortunately, inappropriate care is not just clinically useless, it can be harmful. For example, overuse of antibiotics is leading to increasing rates of antibiotic resistant bacteria. But even more importantly, inappropriate surgery always carries the risk of surgical complications such as post-operative infection.
Why do physicians render inappropriate care?
Answer: The Harvard Business Review article notes that doctors often have an inflated image of what they can accomplish. Also, many physicians order more tests and perform more surgery because of fear that they may be sued otherwise. But, perhaps more importantly, the American health care system is built upon a poor concept of the economics of health care delivery. Americans have been told that the free market will discipline health care delivery and that all we need to do is set market forces loose. Unfortunately, this is a myth. Market forces begin with a ‘beware’ buyer of goods and services. The buyer of healthcare, however, is a patient, not a shopper. When a patient has symptoms, particularly urgent problems, there is neither time nor information to become the ‘beware’ buyer of the market model. In critical healthcare settings, when a doctor offers a diagnosis and points to a possible treatment, the patient is likely to accept the recommendation. In short, the pretense of market forces organizes American healthcare delivery such that it would prefer to make a sale than actually care for a patient. Until we change the underlying ‘marketizing’ of healthcare delivery, we will not reduce the use of inappropriate care.
What can the average American do about inappropriate care?
The Harvard Business Review article mentions educational materials published by the Consumers Union intended to help patients become more informed about choices in healthcare delivery. Each patient can benefit from learning more about their own healthcare and these educational materials are a good start. Additionally, and also mentioned in the article, Americans need to stop falling prey to the fear of rationing (think ‘death panels’) that so commonly surfaces during health system reform debates. Reducing inappropriate care is better for patients, and should be welcomed, not feared.