June 3, 2010

The solution to rising health care costs is patients making informed decisions

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Yale’s Harlan Krumholz blogs on the Forbes site today, making a strong case for shared decision-making even though he doesn’t use that term in his post. Excerpt:

“A few weeks ago I made a modest proposal to the medical profession in the pages of the Journal of the American Medical Association. I suggested that we make informed consent meaningful and provide patients with the critical information that should be available to anyone contemplating a major test or procedure.

I suggested that in non-urgent situations, when there is time for deliberation, patients be told their options, given realistic estimates of risks and benefits, informed about the track record of the institution and physicians who will provide the service, and provided an estimate of the costs to them.

My proposal was to standardize the information to patients who are considering some of the most common elective tests and procedures. Assemble panels of expert doctors and determine where there is consensus about the minimum information that all patients should know. Work with educators and psychologists to determine how to convey the information fairly and impartially. Inform patients that the best decision will be aligned with their values and preferences and that no one decision is right for everyone.

This solution to rising health care costs does not involve rationing care. It does not shift payments to patients or reduce payments to doctors. It does not require complicated legislation or regulation. The solution simply ensures that patients are making an informed decision.”

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pnschmidt

June 3, 2010 at 3:51 pm

There are two proven ways to contain health costs: (1) align financial interests and (2) rationing. The benefit from informed decision making comes from skewing therapies away from the dangerous rather than the expensive. The hazards of informed decision making are twofold: most of the information is provided by the person reimbursed for the service, and decisions made outside of the context of cost cannot reasonably be assumed to reduce cost. For example, for several diseases, there are pills comprised of two generic drugs together in one pill. These combined pills are patented and generally far more expensive than the same drugs would be in separate pills. However, there are no safety concerns over the separate pills and it is marginally easier for the patient to take one pill than two. If cost were part of the equation, no one would buy the combined pills and yet they are widely used. This is the counter-example for informed choice.

Elaine Schattner, M.D.

June 4, 2010 at 2:57 pm

Thanks for this post and alerting me and other readers to the excellent Forbes piece by Dr. Harlan Krumholz. It gives a nice example in cardiology on the value of medical information: when patients know more, they spend less.

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