Dr Alan Garber, MD PhD’s piece in the latest issue of the Annals of Internal Medicine, titled “A Menu Without Prices”, highlights the potential benefits of applying more cost effectiveness (efficaciousness?) analysis to medical reimbursement decisions…
For the well-insured, obtaining health care in the United States is like dining in a sumptuous restaurant that has menus without prices. A price-free menu encourages diners to ignore cost when making their selections. Similarly, well-insured patients usually don’t know the prices of medical services at the time they receive them. Even for common procedures, few hospitals list their charges, much less the accompanying professional fees and the out-of-pocket costs; these are only revealed weeks or months later, when the explanation of benefits statement arrives.
Not a new concept or argument, but Garber does his best to back up the thesis…
By 2005, per capita expenditures were 92% greater than in Canada, 90% greater than in France, 95% greater than in Germany, and 135% greater than in the United Kingdom. Measures of population health have improved no more in the United States than in these countries, offering little comfort to those who presume that uniquely high expenditure is purchasing better health.
A point of contention with the previous paragraph would be the absence of a citation for that claim. It might be in one of the referenced articles, but a point so central to the argument should be cited right there.
As a non-MD member of the Medgadget staff, this Medgadgeteer is more involved with expanding the costs of healthcare with innovative new devices. While effective management of reimbursement is obviously critical to financial sustainability of any system, it does tend to dampen innovation. Innovative new devices are typically the product of small startup companies who don’t have the funding to run years and years of cost-effectiveness studies to prove their product is better than the woeful status quo.
As fans/practitioners/creators of medical technology, we should be wary of (or offer alternatives to) solutions that could dramatically deflate the motivation to innovate.