What's the most important thing for people responsible for carrying out health reform in the country? As Stanford economist Alan Garber, MD, PhD, told New York Times writer David Leonhardt, "Being able to say no is the heart of the issue.” In a piece today, Leonhardt discusses the need to "say no" to needless (wasteful) care, and he outlines a three-step process to curb spending:
The first is learning more about when treatments work and when they don’t. “All too often,” the Institute of Medicine reports, the data is “incomplete or unavailable.” As a result, more than half of treatments lack clear evidence of effectiveness, the institute found. It says the most promising areas for research include prostate cancer, inflammatory diseases, back pain, hyperactivity, and CT scans vs. M.R.I.’s for cancer diagnosis...
The second step - and maybe the most underappreciated one - is to give patients the available facts about treatments. Amazingly, this often does not happen. “People are pretty woefully undereducated about fateful medical decisions,” says Dr. Michael Barry of the Massachusetts General Hospital, an advocate for sharing more with patients...
The final step is the bluntest. It involves changing the economics of medicine, to reward better care rather than simply more care. Health reform doesn’t go nearly far enough on this score, but it is a start.
