Supply of Medical Services

When less is more

Some medical procedures and tests are unnecessary.  Others can even be harmful to patients.  In an effort to reduce the frequency of these services, Consumer Reports is teaming with the ABIM Foundation and nine medical specialty societies to develop evidence-based lists of tests and procedures for patients and physicians to question as part of Choosing Wisely.  According to their website:

The goal of this campaign is to help physicians, patients and other health care stakeholders think and talk about overuse of health care resources in the United States. The campaign is part of the ABIM Foundation’s goal of promoting wise choices bWy clinicians in order to improve health care outcomes, provide patient-centered care that avoids unnecessary and even harmful interventions, and reduce the rapidly-expanding costs of the health care system.

Why would a medical society agree to identify care that is unnecessary?  Some potential reasons, some more cynical than others:

  • Physicians care about patients
  • Physicians want to maintain their reputation as nearly above reproach.  By identifying unnecessary services, doctors will be less susceptible to criticism that they are profit-driven,
  • By creating of list of procedures that should not be done, physicians may be implicitly indicating that the remaining procedures not on the list are on average beneficial to patients;
  • Physicians may place low-margin unnecessary tests on the list, but leave high-margin unnecessary tests off the list.

Most of the current recommendations are very obvious (e.g., don’t give a stress test to people without symptoms, don’t conduct imaging tests for patients with general headaches.   Nevertheless, preventing unnecessary tests can not only help reduce cost, but it can improve patient health.

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