More healthcare is better? You get what you pay for?

The journal Health Affairs just surveyed more than 1,500 patients with employer-provided insurance.   The majority of respondents believe that “more is better, newer is better, you get what you pay for, (and) guidelines limit my doctor’s ability to provide me with the care I need and deserve.”

Healthcare experts can come up with sophisticated ideas for containing healthcare costs.  Congress can simply mandate reductions in Medicare reimbursement.  However, without patient support, we won’t make progress with reducing the burden of the world’s costliest healthcare system.  Lack of patient support is what sunk the healthcare reform efforts of the 1990s.

The question is how to convince the majority of us that “you get what you pay for” but you don’t have to buy everything on the menu or pay more than we should for a therapy when all we have is a scratch or a cough.  When providing the best healthcare possible for our family shows our love and the best means the most costly, when Americans have an innate sense of entitlement for access to the best our healthcare system can provide, we are stuck with in “drive.”   Quick and direct efforts at cost reduction will meet nothing but resistance and failure.

Addressing this challenge will take time.  It took years to convince people to do something as simple and clearly beneficial as wear a seat belt or to not litter.  Healthcare is complex.  We need to develop simple and clear messages, supported with evidence, to change perceptions and the beliefs that are the cornerstone of our society. 

Physicians will play a key role in changing patient beliefs.  Patients will look to their doctor for guidance as to what treatment alternatives are appropriate and which are most beneficial. 

The physician-patient relationship also is complex.  Often, patients listen to their physician without question.  We follow our doctors’ directives solely relying on their judgement.  At other times, patients resist their physician’s guidance and physicians give in to their patient’s demands.  As we are our doctor’s customer, it is a case of “the customer is always right (as long as no harm is done).”  This interaction must be better managed to be more effective.

One approach is to allow doctors more time to educate patients.  This leads us to concepts such as the patient-centered medical home, which we have described in previous blog entries.  Reducing patient loads so primary care physicians can better address patient concerns, providing clinical pathways that guide physician decisions, using EHR to ensure physicians have all data available and redesignining physician and patient incentives to encourage short-and long-term implications of medical decisions will help make the patient-physician interaction more effective and focused on more cost-effective care.

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