Rising Cost of Health Care
You will quickly see why I have to share this today. As some of you know, my husband, Lowell Schnipper, has led ASCO's effort in the national discussion about reducing health care costs while maintaining the best standards of patient care. We all know what a complicated problem this is with so many vested interests and competing values. Hopefully, everyone can agree that, as a country, we want to give everyone the best available care--but we are starting to realize that more is not always better, and that the US is no longer at the top of the list of best medical care systems in the world.
Within the cancer community, the conversation quickly turns to expensive high tech tests, screening tests, and end of life (EOL) care. The first two are less explosive, and there is certainly data to support the non necessity, for example, of scans and other screening tests for all women who are newly diagnosed with early stage breast cancer. If there are reasons for concern, then, of course, she should have the appropriate scans and tests to make the best diagnosis and treatment decision. The conversation about continuing treatment (almost always chemotherapy) at the end of life is much more charged, and it will be very difficult to reach any kind of concensus about best practices. The one absolute universal value is that this always is a decision to be made by an individual doctor and patient, not by others and not by blanket policies.
Here is the beginning and then a link:
The Rising Cost of Cancer Care: Physicians Take Charge
Lowell E. Schnipper, MD
The rising cost of health care has become the focus of a national conversation. Although costs associated with prevention, therapy, and surveillance in patients with cancer after completion of treatment are a relatively small fraction of the total cost of the entire U.S. health care system, the increasing incidence of cancer in the population and greater expense associated with new therapies pose a direct challenge. The effects of physicians' decisions are demonstrated by the substantial regional variations in health care costs that have been documented.
There is good reason to believe that physicians in lower-cost regions order and provide evidence-based tests and treatments just as often as their colleagues in higher-cost regions; however, physicians in lower-cost regions tend to avoid providing care if its usefulness is not well supported by existing data. It can be concluded that if physicians in higher-cost regions ordered tests and treatments in a pattern similar to that followed by physicians in lower-cost regions, substantial savings would be realized.1
In a recent Perspectives piece in New England Journal of Medicine,2 Howard Brody emphasized the overuse of interventions and treatments for which there is no evidence to support use. The assumption that follows is that curtailment of these practices would be associated with enhancement in the quality of health care in the United States, as well as with reduced cost. The Foundation of the American Board of Internal Medicine embraced this concept and developed Choosing Wisely, an educational campaign that is motivated by the importance of conversations between physicians and their patients about the evidence underlying treatment plans. It is anticipated that the consequence of such conversations will be fewer unnecessary interventions, leading to improved patient care and to the notable side benefit of lower cost. ASCO and eight other medical specialty organizations joined this initiative.