Overtreated by Shannon Brownlee

Author:Shannon Brownlee
Language: eng
Format: epub, azw3
Tags: Medical care - United States; Medical care - Utilization - United States
Publisher: Bloomsbury Publishing Plc
Published: 2010-05-21T04:00:00+00:00

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For more than a decade, the drug industry has successfully used direct-to-consumer advertising to boost sales of brand-name drugs, so perhaps it should come as no surprise that the device industry has finally caught on to this marketing tool. After all, it’s their job to sell as many of their machines as they can, and stimulating patient demand for imaging tests is one way to do that. What is surprising is the blinding speed at which many new, medical technologies, not just imaging equipment, are adopted by hospitals and physicians, regardless of their true utility or costs.

One reason it’s surprising that new machinery is adopted so quickly in medicine is that unlike technology in almost any other industry, new medical devices and equipment don’t lower costs. In an industry like, say, steel, investing in expensive technology like automation ultimately brings down production costs by eliminating expensive labor. In health care, by contrast, technology generally drives costs upward. Health care economists say that’s not a bad thing. They argue that medical technology like the LightSpeed VCT may be expensive in the short run, but it would be foolish to impede the flow of such devices into the marketplace, because they improve the practice of medicine. (Besides, new devices and drugs means new jobs for people in the device industry and health care, and new jobs are good for the economy.) The case for encouraging the flow of medical technology has been made time and again in scholarly papers, and it is an argument that carries enormous weight when it comes time for Congress to make decisions about what Medicare will and will not pay for.

Yet the view that all new medical technology is worth the price is often at odds with the evidence and no more so than in the field of imaging. Payments for physician services by Medicare and Medicaid rose 31 percent between 1999 and 2004. During that same period, payments for imaging services grew more than 60 percent, twice as fast, largely because physicians ordered more images per patient and more expensive images. Payments for MRI, for example, grew 140 percent; CT payments went up 112 percent. Now, if the economists were right, the costs of all that imaging would be worth paying because it was actually helping patients. Yet studies of the effectiveness of imaging, including autopsy studies, have shown that the technology is improving care in only tiny increments, even as utilization and costs are rising at meteoric rates. A study performed for the Medicare Payment Advisory Commission, for example, found that patients suffering from heart attacks, hip fractures, and colon cancer did not benefit from more imaging tests.

To make matters worse, simply tracking the spiraling bills we’re paying for all that imaging fails to capture its true cost. Many imaging tests lead to further testing and treatment, whose price isn’t included when economists look at the amount we spend on CT and other imaging. Take the sixty-four-slice scanners that hospitals are snapping up as fast as they can.

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