Take medical uncertainty.
Add financial incentive to treat.
Voila! Increased utilization.
Now take away financial incentive to treat. Guess what you get?
MedPageToday explains in the case of hormone therapy for prostate cancer:
Medicare accomplished what clinical guidelines and evidence-based medicine couldn’t: it reduced unnecessary use of androgen deprivation therapy (ADT) in prostate cancer.
Inappropriate use decreased by almost 30% from 2003 to 2005, following enactment of the Medicare Modernization Act, which lowered physician reimbursement for ADT. Appropriate use of ADT did not change during the same time period, according to an article in the Nov. 4 issue of the New England Journal of Medicine.
“Our findings suggest that reductions in reimbursement may influence the delivery of care in a potentially beneficial way, with even the modest [reimbursement] changes in 2004 associated with a substantial decrease in the use of inappropriate therapy,” Vahakn B. Shahinian, MD, of the University of Michigan in Ann Arbor, and co-authors wrote in conclusion.
“The corollary is that reimbursement policies should be carefully considered to avoid providing incentives for care for which no clear benefit has been established. The extreme profitability of the use of gonadotropin-releasing hormone (GnRH) agonists during the 1990s probably contributed to the rapid growth in the use of ADT for indications that were not evidence-based.”