Choose your battles when resources are scarce

February 1, 2007

In America, we assume that we get what we pay for, whether it be food, clothing or healthcare. Given that healthcare consumes 16% of the Gross Domestic Product and we spend more per capita than any other nation on cutting-edge care, we expect improved outcomes and more bang for the buck. However, these expenditures do not rank the United States first, second or even third in terms of life expectancy, infant mortality, immunization, cancer screening and the like.

In America, we assume that we get what we pay for, whether it be food, clothing or healthcare. Given that healthcare consumes 16% of the Gross Domestic Product and we spend more per capita than any other nation on cutting-edge care, we expect improved outcomes and more bang for the buck. However, these expenditures do not rank the United States first, second or even third in terms of life expectancy, infant mortality, immunization, cancer screening and the like.

Many economists and other researchers ponder why we have not been victorious against cancer and heart disease, for example. One could argue that our attention has been distracted by the need to fight wars against heretofore unknown and insignificant enemies in the hopes of achieving victories. These enemies are less consequential conditions that challenge our way of life: Restless leg syndrome, erectile dysfunction, fungal toenails and others that consume vast quantities of our healthcare attention and resources.

ENEMY CONDITIONS

In the past, when patient copays were minimal, it didn't cost that much to start a new healthcare war. All you needed was a few well-placed headlines, a cute animated critter symbolic of the condition, a surf-and-turf dinner for doctors and a promise to patients that they could be saved through a prescription or test with a $25 copay.

Many times, it didn't really matter to patients whether or not they were war victims. It became socially acceptable to announce that you too suffered from one of these terrible conditions. As long as the rules of engagement required only a modest copay, few patients cared what these wars cost and whether these wars were worth fighting.

FEELING THE PINCH

But now, with the advent of high-deductible health plans, higher copays and greater patient financial responsibility, the battleground is beginning to change. It's one thing when the barrier to entry costs no more than a beer and lunch. When the price of joining the war costs patients $500 or $3,000, signing up doesn't look as appealing. In the meantime, though, legions have been committed to fight the war.

Wars cost money and consume resources. As our top generals are distracted, we have elected to fight the day-to-day battle with troops more focused on reacting to the patient's perceived "needs," rather than ascertaining what truly needs to be done to return the patient to health.

Perhaps the question isn't whether we are winning the healthcare wars, but rather whether we are fighting the right wars.

MHE Editorial Advisor Joel V. Brill, MD, is chief medical officer of Predictive Health LLC.

Dennis A. Robbins, PhD, MPH, an MHE editorial advisor, serves as an advisor on ethics and related issues for national organizations, law firms, hospital systems and government.