The New York Times last week wrote an article (“…off the charts…“) examining the use of invasive treatment for cardiac problems in Elyria, Ohio. The article says that this small city has angioplasty rates which are significantly higher than any other U.S. city.
“…outside experts say such a locally dominant cardiology group could make it hard for patients to be aware of other treatment options. They also say there is no clear medical reason for so many patients in Elyria to be so much more likely than heart patients elsewhere to require angioplasty.”
On the other hand, Kaiser Permanente’s salaried doctors in Ohio have an incentive minimize care:
” ‘It’s not just individual doctors making up their minds,’ explained Dr. Ronald L. Copeland, the executive medical director for Kaiser’s medical group in Ohio. With no financial reason to perform expensive procedures, the Kaiser doctors frequently choose to manage the patients’ heart disease with drugs only. ‘Our doctors have no disincentive to do that,’ Dr. Copeland said.”
It is important for healthcare consumers to realize that doctors respond to financial incentives just like the rest of us.
“…some outside experts say they are concerned that Elyria is an example, albeit an extreme one, of how medical decisions in this country can be influenced by financial incentives and professional training more than by solid evidence of what works best for a particular patient.”