A more palatable path to rationing

Rationing is a very dirty word in America, evoking grim images of wartime Great Britain and –in the health care context– withholding of needed care from patients based on cost. But cut back on costs we must, and with magical thinking about the deficit becoming every more popular, we’ll have to find other ways to convince folks to do it.

Patient safety is a promising guise under which to achieve cutbacks, especially in costly areas where the dangers are real. The new radiation protection bill signed into law in California yesterday is a great example. From AuntMinnie (Calif. governor signs medical radiation bill into law):

The bill requires that radiation dose be recorded on the scanned image and in a patient’s health records, and that radiation overdoses be reported to patients, treating physicians, and the state Department of Public Health (DPH).

The law is clearly focused on overdoses, but once patients realize how much radiation they’re being exposed to –especially by repeated CT scans– many will start cutting back on what they request or accept. Over time, perhaps this attitude will spread to other areas of medicine such as surgical procedures and prescription drugs, where the risks are not always recognized today.

The federal government has done a great job whipping people into a sustained frenzy about airport security. All the time I hear people say they’ll put up with whatever hassles it takes at the airport in the name of security, and it almost seems the greater the hassle, the more satisfied people are to be subjected to it. I don’t admire this approach in airport security, but if the same zeal were devoted to patient safety (with the idea of reducing health care costs) I think it could succeed.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma,  biotech, and medical devices. Formerly with BCG and LEK. He blogs regularly at Health Business Blog, where this post first appeared.

Categories: Uncategorized

Tagged as:

3 replies »

  1. “Patient safety is a promising guise under which to achieve cutbacks…”
    Your phraseology is unfortunate. Patient safety is not a guise for anything and should never be presented as such. People are already confusing comparative effectiveness research with cost cutbacks; don’t further contribute to the misunderstandings, or we will never achieve effective, efficient and safe medical care.

  2. Good point David. While we are in an era of patients becoming more informed about their own health and treatment avenues, they still largely do not understand everything that health care entails.
    Doctors have been published frequently as saying that patients come into their offices demanding procedures, tests etc. Perhaps a move towards educating patients about the cost-benefit ratio is the best way to combat this pressure.
    Patients don’t realize the radiation they are exposed to via CTs. Patients don’t realize that receiving a hysterectomy could end up causing more problems for them than benefit.
    If doctors do begin to push back against patients but armed with simple data that highlights risks, it may help to ration care in a way that is best for the patient and our runaway health care costs.

  3. This is interesting and important. It does highlight a problem with “too many tests”. However, the problem is too many unnecessary tests.
    “Rationing” is limiting access to NECESSARY care and tests. We have a long way to go in eliminating duplicate, overpriced and unnecessary tests and care before anybody has to think about rationing.