HEALTH CARE OUTCOMES: WHEN THE MORE EFFECTIVE CHOICE COSTS MORE
(Part 1 out of 2)
(Part 1 out of 2)
by Mark Pauly
The American health care system would surely work better if all physicians responded to new evidence on what kinds of care work better as soon as that evidence is definitive. That sturdy truism is at the valid core of the essay, “What Really Stands in the Way of Cutting Health Care Costs” by Ngan MacDonald and Walter Linde-Zwirble, which was published on this Blog last October 8th and 13th.
But the consultant-authors of the essay ironically overstate the evidence that such a policy would lower medical care spending, and they provide almost no evidence that there exist feasible ways to get doctors to respond faster.
The argument that focusing on physician response to evidence would be an effective (much less the best) way to control cost is not one for which there is a lot of support.
There has been considerable emphasis in medical circles on “evidence-based medicine” as a tool for improving the quality of care, although that discussion dealt much more with the need to develop better evidence on what clinical treatments work best in the vast areas of practice where such information is imperfect.
As part of the Affordable Care Act, the federal government is spending millions on studies to determine which clinical treatments are more effective through a new agency called the Patient Centered Medical Outcomes Institute (PCORI).
But there is already research suggesting that improved information on comparative effectiveness (from PCORI or other sources) may not lower spending.
While it is surely possible to find examples of situations in which current clinical practice in the absence of good evidence may favor a higher cost strategy than the one which, after evidence is collected, turns out to be more effective, there are also examples where the more effective treatment costs more than the less effective one. It is an empirical question with two parts:
But the consultant-authors of the essay ironically overstate the evidence that such a policy would lower medical care spending, and they provide almost no evidence that there exist feasible ways to get doctors to respond faster.
The argument that focusing on physician response to evidence would be an effective (much less the best) way to control cost is not one for which there is a lot of support.
There has been considerable emphasis in medical circles on “evidence-based medicine” as a tool for improving the quality of care, although that discussion dealt much more with the need to develop better evidence on what clinical treatments work best in the vast areas of practice where such information is imperfect.
As part of the Affordable Care Act, the federal government is spending millions on studies to determine which clinical treatments are more effective through a new agency called the Patient Centered Medical Outcomes Institute (PCORI).
But there is already research suggesting that improved information on comparative effectiveness (from PCORI or other sources) may not lower spending.
While it is surely possible to find examples of situations in which current clinical practice in the absence of good evidence may favor a higher cost strategy than the one which, after evidence is collected, turns out to be more effective, there are also examples where the more effective treatment costs more than the less effective one. It is an empirical question with two parts:
- How often is the more effective treatment cheaper?
- How often are physicians mistakenly choosing the less effective treatment?
On the first point, a research team from Wharton, Penn Medicine, and Pfizer, Inc., recently reviewed a database of the thousands of studies of comparative effectiveness and comparative costs of a variety of clinical interventions, most of them novel.
We found that in only about a quarter of the studies was the more effective treatment the one with lower cost. However, we found better news about a more relevant issue: In more than four out of five studies, the more effective treatment was worth the additional cost.
If in these instances doctors had switched to the more effective treatment, in the great majority of cases that would have led to care of enough value to justify the cost, even if the cost would have been higher. In such cases, net value, not cost containment for the sake of cost containment, should be our social goal.
We found that in only about a quarter of the studies was the more effective treatment the one with lower cost. However, we found better news about a more relevant issue: In more than four out of five studies, the more effective treatment was worth the additional cost.
If in these instances doctors had switched to the more effective treatment, in the great majority of cases that would have led to care of enough value to justify the cost, even if the cost would have been higher. In such cases, net value, not cost containment for the sake of cost containment, should be our social goal.
Fuente: KNOWLEDGE@WHARTON
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