Overtreated with unnecessary CT scans
June 30th, 2008 | by Brian Schwartz |
The New York Times reports on how expensive CT scans for heart disease are often unneccessary, and relates one case where the patient probably did not need the scan: The doctor “said the scan would be valuable anyway because it might reassure him. And his insurance would cover the cost.”
I understand the motivation to want reassurance. But that’s a lot easier to ask for when insurance covers it, so it appears free to the patient, or prepaid through his insurance premiums. Yet, our tax system subsidizes insurance, so we are more likely to buy policies that resemble prepaid medical care that insulates us from the true costs of wanting reassurance.
Writes the Times:
One reason for high health care costs is that some expensive tests are frequentyly used even when they have not been proven to provide more useful information that older and cheaper tests.
More from the article:
CT scans, which are typically billed at $500 to $1,500, have never been proved in large medical studies to be better than older or cheaper tests. And they expose patients to large doses of radiation, equivalent to at least several hundred X-rays, creating a small but real cancer risk. …
And yet, more than 1,000 other cardiologists and hospitals have installed CT scanners like the one Dr. Rosenblatt turned down. Many are promoting heart scans to patients with radio, Internet and newspaper ads. Time magazine and Oprah Winfrey have also extolled the scans, which were given to more than 150,000 people in this country last year at a cost exceeding $100 million. Their use is expected to soar through the next decade. But there is scant evidence that the scans benefit most patients. …
Sometimes, it is not the doctor but the patient who is eager for the scan. …
Dr. Hecht acknowledged that Mr. Franks probably did not have severe heart disease. But he said the scan would be valuable anyway because it might reassure him. And his insurance would cover the cost.
Arnold Kling comments:
The Times falsely says that “At a time when Americans are being forced to pay a growing share of their medical bills…”
If only. What the story misses, and what my book emphasizes, is that these expensive, discretionary medical procedures are spurred by insulating the consumer from the cost, thanks to what we call “insurance.”
In an earlier post, Kling describes this problem in depth:
For health care providers, insulation is a bonanza. Because consumers are not spending their own money, they accept doctors’ recommendations for services without questioning them and without concern for cost. Faced with an insured patient, a health care provider is like a restaurant catering to convention-goers with unlimited expense accounts. The customer will gladly take the most high-end recommendation and not worry about the price.
Consumers are happy as well. Insulation relieves the patient of the stress of making decisions about treatment. The patient also does not have to worry about shopping around for the best price.
The problem with insulation is that it is not a sustainable form of health care finance. Individuals, employers, and government are all under stress. …
Insulation leads people to over-consume health care services. Americans make extravagant use of services that have high costs and low benefits. Many studies that compare groups with similar conditions show that those with the largest levels of health care spending fare no better in terms of outcomes than those that spend less.
(HT, Arnold Kling, of course)
tags: Overtreated
