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Archive for 2 mayo 2012

All over the world, healthcare costs are skyrocketing, no wonder the amount of ideas that are piling up in lay and professional media. But, with very few exceptions, the ideas for reducing costs concentrate on the final user, and very few focus on the real cost drivers of healthcare.

Let´s concentrate on Europe and its well-established national health systems (NHS). The current trend is to make people pay as they go, so to speak. The idea is that, if you have to pay more for your medicines, you will be more careful. Paying to go to the family doctor will make you think twice before making an appointment.  And so forth.

The logic behind this is that either the individual is the main cost driver or, alternatively, that the NHS as we know it is unsustainable.  Therefore, we should work towards a system based on pay-as-you-use.

Today I am going to concentrate on the firs aspect: healthcare cost drivers.

In my case, I certainly go to the doctor when I need to. If I have to pay for this, I might  put off  visiting the family doctor when I perceive the first symptoms of a cold, and wait till I end up with pneumonia.  This will certainly require a more expensive cure. There are also other things that I could be charged for, such as prescriptions or blood tests.

But, am I the one who decides to take a certain medicine? Am I the one who decides that I need a prescription? No, it is the doctor who treats me that decides what I need.

Back in 2010, Dr. Howard Brody published an article (Medicine’s Ethical Responsibility for Health Care Reform — The Top Five List http://www.nejm.org/doi/full/10.1056/NEJMp0911423 ) criticizing the performance of medical groups, saying they were too concerned about protecting doctors’ incomes while refusing to contemplate measures to reduce health care costs and pointing out that “…the myth that physicians are innocent bystanders merely watching health care costs zoom out of control cannot be sustained.”

What is true for the USA is even more so for the NHS in Europe. On this side of the Atlantic there are few checks on what a doctor expends. In some countries there is even complete ignorance of the cost of a particular diagnostic test. Duplicated tests, meaningless tests and the like are the main cost drivers that could end up making the NHS unaffordable. If we aim at having sustainable universal healthcare coverage let´s start by focusing on the real cost drivers: the medical profession. We should work towards making doctors aware of the cost of their decisions, so that they can balance the cost-benefit of their medical decisions.

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