Cost Containment and the Physician

Abstract

The rapid rise in health care costs is receiving a good deal of attention these days. Proposed responses include the deliberate rationing of expensive medical technologies, such as organ transplantation, and a redirection of our efforts toward preventive care. Although preventive care may improve our health, it cannot be assumed to reduce medical costs, since a later death may be as expensive as an earlier one. I suggest that a major and rapidly growing component of medical costs stems from the widespread application of tests and procedures when they are of no demonstrated benefit and may even be harmful. Identifying and curtailing such unnecessary medical care, rather than rationing beneficial technologies, should be the thrust of cost-containment efforts. Fee schedules should be revised so that they neither encourage nor discourage the use of tests and procedures; we should undertake systematic studies to assess technologies and practices; and we should make every effort to discourage the practice of defensive medicine. The involvement of physicians in rationing is not only premature; it is also inconsistent with our role as advocates for the health of our patients.

Validation of the Ottawa ankle rules in a second-level trauma center in Italy

“…The positive predictive values of the OARs were 45.9% (95% CI, 13.9%-51.5%) for malleolar zone fractures, 41% (95% CI, 30.0%-74.2%) for midfoot fractures, and 43.3% (95% CI, 19.9%-45.2%) for all fractures. The positive likelihood ratios were 2.3, 1.7 uncommonly used medical interventions [26][27][28]. In addition, patients are more satisfied if they do not have to undergo radiography [26].…”

Should Research Ethics Encourage the Production of Cost-Effective Interventions?

“…Likewise, some argue that before imposing limits on interventions that are not cost-effective, we must first address wasteful spending elsewhere, such as in national defense (Angell 1985;Daniels 1986;Schrecker 2013). However, while wasteful defense spending may mitigate the culpability of medical researchers who pursue research on cost-ineffective interventions for the resulting avoidable morbidity and mortality, it does not eliminate their culpability, just as criminals' culpability does not eliminate crime victims' responsibility to avoid injuring innocent bystanders in self-defense (Hurka 2005;McMahan 2011).…”

Physician Conceptions of Responsibility to Individual Patients and Distributive Justice in Health Care

“…To avoid this confl ict, many have argued that physicians ought be responsible only to individual patients. 6,7,15,17,[20][21] At the extreme of this view, physicians have been found to deceive third party payers or manipulate reimbursement rules to secure payment for necessary patient care. [23][24][25] The argument about whether physicians ought to withhold marginally benefi cial services from some persons so that others have access to health care is fundamentally a debate about distributive justice.…”