The cost of healthcare is stifling. It is crippling the budgets of individuals, families, businesses, communities and state and federal governments. It is, and should be, the concern of every person in our society. The attitude, ‘I've got health insurance, let somebody else pay for it', is careless and undermining.”
I wrote that paragraph 20 years ago, and unfortunately, the increasing cost of healthcare continues to be unrelenting. Little has changed except for the volumes of legislation that are confounding the implementation of society's most vital need: the delivery of disease prevention and treatment.
While advances in medicine continue to be spectacular, rising healthcare costs are unabated. Medical services are a priority, yet the consumer (patient) and the provider (physician) are not cognizant of the specifics of these expenditures until after the service, test, study and/or treatment have been rendered. Medical care is the only service delivered prior to the principals in the study-service-treatment equation becoming aware of the costs—often a long time after the event.
The purpose of this essay is to offer fundamental suggestions that I believe will help control the cost of health services.
Medical professional organizations should “recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health,” according to the American Medical Association's Principles of Medical Ethics. If it is predictable, it is preventable. Ideally the commitment should include informing the public of the health hazards of high-risk behavior beginning at an early age as a continuum of personal hygiene and health science education.
Seventy-five percent of healthcare costs originate with the medical provider, yet, for the most part, they are unfamiliar as to cost. The control of healthcare costs begins with the physician as the cost of all decisions must be factored into the benefit/value deliberations for the patient. The patient as well as the provider should know the price of the treatment at the time it is being ordered.
Physicians should post and make available their fee schedules. Indeed the cost of hospitalization, consultants, laboratory tests, pharmaceuticals, X-rays and durable medical equipment should also be known in advance. Medical institutions, drug companies and medical suppliers should curtail direct-to-consumer advertising.
Physicians are colleagues, not competitors! No one person can know it all. The most important thing for a physician to know is what she or he does not know and to direct the patient accordingly. Good medicine is practiced in harmony with one's colleagues, similar to an orchestra.
The cost of medical liability insurance is prohibitive and in Massachusetts, for example, it is required in order for a physician to receive an active medical license. An obstetrician pays in excess of $100,000 a year ($2,000 a week) for professional liability insurance. Meanwhile, additional costs for lab tests and X-rays performed to protect a physician from the threat of being sued for failure to diagnose a remote, unlikely or rare malady are exorbitant.
Medical liability claims should be promptly adjudicated. Prolonged resolution (five-plus years), demanding defendant silence and denying the sharing of experience with colleagues is a profound deficiency of the litigation process leading to physician preoccupation, depression, early burnout and even suicide.
The most effective way to lower the cost of healthcare is to stay healthy. Preventing a disease is the best option. Learning and practicing prevention is the hallmark. The fact that 20% of adults still smoke cigarettes more than two generations since the U.S. surgeon general's first report of the harmful effects of tobacco in 1964 is a conspicuous example of the power of addiction and the failure to effectively reach our teenage population.
The plague of the 21st century, in my opinion, is illicit drug use. Nearly three people a day die from drug overdose in Massachusetts. And, most alarming, is the fact that the population of the U.S. represents only 5% of the world's inhabitants, yet we consume 65% of the world's illicit drugs!
Establishing a trusting medical provider-patient relationship offers the best assurance for responsive medical attention. Ideally the relationship should begin at a time when the patient is well; a medical record is established and preventive health disciplines are addressed.
Traditionally, when a patient requires hospitalization their physician is responsible for directing the daily management. Hospitalists are now assuming that responsibility, bypassing one's personal physician. This interception leads to patient confusion, often delayed communication, duplication of testing and disruption of continued responsibility of care at the time of hospital discharge.
Illness and injury are complications of living. Everyone must be reminded to budget accordingly in order to pay a portion of their health insurance premiums and to become a more discerning, cost-conscious patient.
Health insurers should finance the cost of accepted preventive medical services, including annual examinations, immunizations and professionally agreed upon medical testing based on predictability statistics for age, family history, occupation, environmental conditions and other personal risk factors.
Failure to seriously address these issues will result in the continued increase of medical costs. Ethically and professionally, the needs of the patient are foremost. While everyone is important and care of the patient comes before his or her ability to pay, the goal is for everyone to become more cost-conscious.
Dr. Leonard Morse is a professor of clinical medicine and community health at the University of Massachusetts Medical School.