This week's question for the Washington Post Health Care Rx blog was:
What does the debate over mammography screening teach us about the challenges in moving to evidence-based medicine in a revamped health system?
The debate truly highlights how much work is yet to be done to build a health-delivery system that generates enough accurate data so that we can truly 'know' the evidence! More importantly, however, it underscores two fundamental issues impacting broader health care reform:
1. The USPSTF made a recommendation for an 'overall population' vs. an 'individual' choice for a doctor and patient. The funny thing about statistics is that they're about percentage risks for a population, but individuals have different genetic profiles/risks, and attitudes and priorities around health. There is no one right answer for everyone. If the health sector were more market-oriented like other industries (people have different 401k investment plans, different savings rates and the like) and not driven by health insurance companies or the government making determinations about what is 'right', consumers would explore the information available and make their own choices with their physicians.
2. Insurance should address catastrophic events, not every day expenses. Yet people expect insurance to cover every doctor's visit, test and treatment, which is economically inefficient and establishes the wrong incentives for providers and consumers. People should pay for routine care -- doctor's visits, mammograms, routine medicines -- and only tap into health insurance when they need to cover major, unpredictable issues. If people were in charge of paying themselves, they would be more engaged in their health and understand how their choices impact themselves and others. Differentiating major medical coverage from full health coverage would reduce the incentive for some to over-consume health resources. This would enable more innovation in insurance and health delivery and make health care more affordable for all.
Evidence-based medicine is the 'brass ring' for health-care reform. Medicine is going to continue to evolve and improve, and we need the right system in place to ensure that individuals have the information they need to make informed choices about their care to drive the best outcomes for their health.
Actually all of the data shows that when you shift first dollar costs to patients they put off needed preventive care and medications and end up needing much more expensive care in the future. The best example of this is people who lack health insurance and those with high deductible plans or those who pay for an individual policy (in your State for a man your age it would be over $600 a month). I guess your health care costs are born by everyone who buys microsoft products though so it is hidden from you.
The average person is not in any position to shop for health care and you know clearly know that the bulk of the money is spent on the small 10 or 15% of people with chronic or life threatening conditions often in the last year of their life.
The best outcomes are being achieved by systems that pay for the first dollar of care for people who are diabetic or have high blood pressure and in France (which doesn't have socialized medicine) the sicker you are the more coverage and care you get up front.
Recently you blogged about your own families experience and it demonstrated that even highly educated very wealthy people like you don't make decisions based on cost or quality. You picked the most expensive hospital in the Seattle area even though the hospital (trauma center level) closest to your home costs 30% less and has higher quality outcomes.
Here is another simple example, there are over 1 million unnecessary hysterectomy's in the country each year but do you honestly think most women (the average literacy level in the US is about an 8th grade) would question their doctors advise? Would your wife suggest in the ER if your having a heart attack that you be transferred to a more cost effective hospital?
You seem so far removed from the reality of the typical American family who have an average income of $45,000 a year. Guess what they do? They do without meds and care and end up sicker and in our ER's.
Just curious if you can provide any early feedback from the Scripps Translational Science Institute, Navigenics, Affymetrix and Microsoft study? It seems clear that creating a secure, unified, intelligent, and collaborative framework for individuals, patients, and families is the first step to realizing the benefits of Evidence-based medicine.