Wouldn’t you be interested in getting the best value for money spent? In an interesting study documented in the Annals of Internal Medicine, the authors reviewed over 2,000 peer reviewed articles on new innovative therapies that included both cost and benefit in their analyses. While most of these increased cost and benefit, there were a few that saved a significant amount of money in exchange for a very small decrease in quality: savings from $122 to $12,000 in exchange for losses in
quality-adjusted life years of about eight hours to one week. Examples included doing percutaneous coronary interventions vs. more expensive open heart surgery, watchful waiting for inguinal hernias instead of routinely operating on them, and using drugs to treat reflux disease with symptomatic heartburn instead of laparoscopic surgery.
The point is that it’s possible to get good outcomes with cost-saving innovations, even if those outcomes are slightly less effective than more expensive options. But will your doctor routinely inform you of the cost benefit of various options? No, primarily because you are not the one paying the bill. Instead, there is a “race to the top” in medical innovation, as plans pay for ever more expensive high tech innovations (and pass it along to you in the form of higher premiums). In other parts of the economy, consumers know the tradeoffs between cost and quality, and make purchasing decisions accordingly.
Given our fixation on getting a grip on stratospheric health care costs, maybe it’s time we think of ways to give consumers the option of spending far less money in exchange for giving up a slightly greater benefit. Perhaps then we would see who is really interested in “bending the cost curve.”