Five Easy Theses by James Stone

Author:James Stone
Language: eng
Format: epub
Publisher: Houghton Mifflin Harcourt

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Overutilization of testing is well known as a source of excessive cost. One driver of the excess is misdirected competition among hospitals that causes each of them to purchase and offer the most sophisticated technology regardless of normal supply-and-demand considerations. Another part of the problem is defensive medicine in response to threat of litigation.

Technology can save lives, and properly used, it can doubtless save money in just about every sector of the economy. There is virtually no limit, though, to what it can cost us all if its application is unrestrained. This is particularly so with respect to medical testing technology. Unlike doctors’ incomes, this is a source of expense where expert opinion is nearly unanimous about savings to be found by eliminating excesses. I was unable, to my surprise, to find a reliably sourced estimate of the annual total of spending by Americans on medical tests, but an educated guess would put the aggregate cost at something like half a trillion dollars a year. One trade journal reported in 2009 that diagnostics account for 10 percent of all health-care costs, but other sources suggest a much higher number.36 A loose estimate used by writers in the field is that one-third of the testing and diagnostic cost total is wasted.37 What we can say for sure is that America’s health-care system incentivizes substantial unnecessary testing costs.

The American Board of Internal Medicine Foundation has compiled reports of twenty-five medical specialty societies and determined that the routine use of 130 different medical screenings, tests, and treatments should be scaled back. The societies jointly released lists of these tests in a campaign they called “Choosing Wisely,” which urges patients to question certain testing recommendations.38 There are now about eight thousand distinct diagnoses.39 If we tested for all of those that are nonzero possibilities in a patient, we would break the health-care bank. The newest budget buster is genetic testing, which friends at Cold Spring Harbor Laboratory tell me is now just on the verge of yielding clinically useful results. A medical journal estimates that molecular and genetic tests will soon, though, represent as much as one-third of all diagnostic testing costs.40

A personal story recently added to my education on misaligned incentives in the medical testing arena. Over the course of my early sixties, I noticed a mild impairment of hearing in the upper frequency ranges. So, I thought I ought to track it and asked for a routine hearing test, the kind where you raise your finger whenever you hear a beep. The test confirmed what I knew and added useful quantification. Then, about a week later, I received a letter from the hospital that had administered the test, suggesting an MRI. The logic was that my two ears had less than identical results, and thus a scan for a rare type of inner-ear tumor would be wise. Most people, presumably, would have gone for the test promptly, but with excesses in health spending on my mind, I decided to do some research.

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