Since the implementation of the
Patient Protection and Affordable Care Act of 2010 several
weeks ago, experts have continued to study the new healthcare
reform laws to evaluate the full effect on our country’s
healthcare landscape. But while the law does much in
addressing the needs of those who could not receive medical
insurance coverage previously, many argue that it does
not go far enough to address the overuse of medical care, one
of the major factors in controlling healthcare costs. In
fact, several in the medical field have come forward to say
that the new laws do little to change the nation’s chronic
overuse of healthcare and it does even less to incent doctors
to help curb the practice.
Experts like Jonathan Gruber, a
health economist at M.I.T., agree that changes must be made in
these areas because the nation is on an unsustainable
path. “Unless we are prepared to spend 50 percent of our
GDP on healthcare,” he said, “it has to happen.”
Other healthcare experts share
the view that while the financial impact of overuse was a
major reason for the reform of healthcare, the end result was
a reform of health insurance, and thus, the key issues of
utilization remain unchecked. According to a recent
article in the New York Times, these doctors and economists
believe that in order to truly change the chronic overuse of
medical care, changes have to be made in the way patients
think about healthcare (expectations), how medicine is
practiced, and how it is financed. But the new laws are
focused more on the latter (paying for care), and while they
do contain minor provisions regarding wellness and comparative
effectiveness research, many fear they do not go far enough to
address the other two areas.
Expectations around
Healthcare
In most cases of overuse, one problem
that many physicians face is patient perception of
healthcare. Quite often, patients want the latest and
greatest treatments available even if they are deemed
unnecessary and/or too costly. Others often choose to
take medications rather than practice preventive wellness
measures that could have a greater impact on their overall
health. Physicians note that comparative effectiveness
research could give patients additional guidance on what tests
and treatments are better than others, but current reform laws
offer nothing to force patients or doctors to choose one
treatment over another or to choose the most cost-effective
alternative. As stated by Bryan R. Luce, senior vice president
for science policy at United Biosource Corporation, “There is
no direct link between the development of that evidence and
the use of that evidence.”
Changing How Medicine is
Practiced
While physicians realize the need to
curb medical overuse, they currently lack any incentive to do
anything other than cater to patient demands. The
current reform laws lack any significant changes to the
current reimbursement system, under which some doctors can
often profit from ordering additional tests. The laws do
include Medicare pilot programs that reward doctors for
delivering better care at lower cost, but such programs are
still in the testing phase and some question as to how long it
will be until they are translated into Medicare
policy.
Overrunning the Emergency
Rooms
Other experts are concerned that a shortage
of physicians could lead to exacerbated overuse of emergency
rooms. With the reform law bringing more uninsured
into the healthcare pool, a lack of qualified doctors to
handle influx of new patients could push more to the ER, which
is already flooded with patients who could be getting more
efficient and cost-effective care from a primary
physician. The expansion of Medicaid may help to some
degree, but chances are ER utilization will continue to
skyrocket.
Is Rationing
Next?
When it comes to healthcare, Americans
generally do not want to be told what medical care they can or
cannot receive, and any attempt to attack overutilization
could result in strong public backlash. However, without
a widespread paradigm shift, many experts believe rationing
care would be the next logical step to addressing the
issue. Such measures may involve the creation of a
government-appointed task force to determine what care is
acceptable – and that may not sit well with the general
public.
“Rationing” is, after all, a word
that nobody wants to use in this situation. “It’s just a
firecracker – nobody wants to touch it,” said Dr. Robert D.
Truog, a professor of medical ethics, anesthesia, and
pediatrics at Harvard Medical School. “The point is that
as long as a healthcare system has anything less than an
infinite budget, there is a need to decide which types of
healthcare will be funded and which will not.”
Is this the direction healthcare
reform is taking us? There may be no definitive answer
to that question, but the reality is: as long as healthcare
financing is the only item addressed and overutilization
continues with no personal responsibility, it is unlikely we
will see any real reductions in healthcare trends.
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