Friday, August 17, 2012

US Healthcare Costs Explained



Here's another facet to the phenomenon laid out in the previous post.

Coming into work today, I was struck by the latest radio advertising from CPMC (a San Francisco hospital) touting "Robotic-Assisted Cardiovascular surgery".  Being the cynic that I am, I was skeptical that this new procedure was clearly better than previous surgeries and my brief reading of the literature confirmed my suspicions.  But this highlights why our systems costs so much more than any other country, without improving outcomes.

1)  Americans love technology.  CPMC is not stupid.  They feature "Robotic-Assisted Cardiovascular Surgery" because that's what people think the latest and greatest medical breakthrough should sound like.  CPMC is merely giving what the people want:  High-tech, unclear benefit healthcare.

2)  The American System doesn't care about costs.  Medicare is expressly forbidden to consider costs in coverage decisions.  As you may guess, Robotic assisted surgery uses more high-tech equipment and thus the justifiable costs are higher.  So, the hospital buys expensive equipment (making the medical manufacturer happy), then tries to use is aggressively to recoup costs.  See this post about the financial aspects of robotic surgery:  http://skepticalscalpel.blogspot.com/2012/02/study-robotic-surgery-financials.html

Multiply this scenario by hundreds of hospitals around the country, by hundreds more types of technology and you get a sense of why the US spends over 2x as much on healthcare as the UK without clear improvement in health outcomes.  We as a country repeatedly choose to pay more for the same health outcomes.  It's as if we decide to buy a chair, find the exact same one at 2 stores and choose the one at the more expensive store because the store is newer and has fancier elevators.

To be fair, we may find years later than robotic technology does lead to clear benefits.  But we don't know that now and there any tons of examples of new technology that sounded great that hurt, rather than helped in the long run (e.g. all metal prosthetic joints).  CPMC is operating as a rational business entity, like most hospitals these days.  The surgeons involved probably have seen many positive outcomes with this procedure and probably fervently believe that what they are doing is saving lives.  However, the US system lacks a grown-up who is making the tough decisions about where limited resources need to be spent, and that leads to a free-for-all where everyone is spending money we as a society don't have for unclear benefits.

by: Sei Lee

3 comments:

Anonymous said...

I read this and the previous post with interest. I believe one other issue contributes to the high cost of medicine and that is nursing and others unwillingness to question prescriber orders when they are inappropriate or the proscriber making it difficult for someone who questions an unneccessary order. This can also impact palliative and or end of life care. Four examples to show what I mean:
Patient is admited for an appendectomy. should be an overnight holdover but he reports his pain is not controlled so he is now admitted (so far this is okay). Now the patient is compaining of numbness in his knee and difficulty walking (he had GA nothing spinal). His nurse wants to call the covering surgion and ge him PT, an ortho or a neuro consult, and tests. I suggested this had nothing to do the appy and could be handled out patient. She said she would let the doctor make that decision. He decided on an US of the knee.
A women in her 40's who had liver mets of an unknown primary. Noone was able to get a peripherl IV in and she refused a central. an US of the liver showed good perfusion. Two different hospitalists wanted an CT angiogram of the liver and were angry when oncology canceled them. They wanted to "know".
87 year has seizures, transfered to the unit, went into renal failure, family after talking to nursing makes him comfort care (through his family doctor). Neurologist was fureous because now we won't know what caused the seizures.
Forth, patient receives Taxol for cancer (ordered by Oncologist). Hospitalists orders ECHO because of the Taxol. Would not listen to the oncology nurse that Taxol does not call for an ECHO (or MUGA scan).
How much waste comes from unecessary tests or procedures because someone wants to know?

April Thomas said...

It seems we're starting to enter the era of "cure that patient at all costs". I'm not saying it's a bad thing though; what I'm saying is, if they have this as a mindset for healthcare, they ought to have the cash to back it up.

Aidan Morrissons said...

I'm really glad that technology never stops in innovating. With this, things could be done easily. This "robotic-assisted cardiovascular surgey" sounds really interesting. But as one of the medical aid unit delaware team, My question is that, will it available anytime? anywhere? Will the country invest on this?