Monday, July 25, 2016

How can we control rising health care costs while still assuring optimal patient care?

Ethics of the Physician’s Role in Health-Care Cost Control

The United States health-care expenditure is rising precipitously. The Congressional Budget Office has estimated that, in 2025, at our current rate of increased spending, 25% of the gross domestic product will be allocated to health care. Our per-capita spending on health care also far exceeds that of any other industrialized country. Health-care costs must be addressed if our country is to remain competitive in the global marketplace and to maintain its financial solvency. If unchecked, the uncontrolled rise in health-care expenditures will not only affect our capacity to provide our patients with high-quality care but also threaten the ability of our nation to compete economically on the global stage. This is not hyperbole but fiscal reality.

As physicians, we are becoming increasingly familiar with the economics impacting health-care policy. Thus, we are in a unique position to control the cost of health care. This includes an increased reliance on creating and adhering to evidence-based guidelines. We can do this and still continue to respect the primacy of patient welfare and the right of patients to act in their own self-interest. However, as evidenced by the use of high-volume centers of excellence, each strategy adapted to control costs must be vetted and must be monitored for its unintended ethical consequences.

The solution to this complex problem must involve the input of all of the health-care stakeholders, including the patients, payers, and providers. Physicians ought to play a role in designing and executing a remedy. After all, we are the ones who best understand medicine and whose moral obligation is to the welfare of our patients.

Comment: This is such an important issue, yet many of our actions fail to address it: we continue to order tests that are not needed for the evaluation and management of the patient, we continue to develop and promote more complex and expensive technologies without evidence that they improve the outcome for the patient, and we continue to perform major surgeries in low volume settings, in spite of the evidence that this practice is associated with inferior outcomes. In our view, the issue is best addressed, not by a top-down set of directives, but rather by individual surgeons advocating decisions that are in the best interest of their patients and of the health care system of the nation.