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Why is cost-effective care so difficult to achieve?

Why don't more health organizations adopt cost-effective approaches to delivering care? That's the question addressed today in a New England Journal of Medicine perspective from Stanford's Victor Fuchs, PhD, and Arnold Milstein, MD, MPH. The answers, they say, "lie in the perceptions and behaviors of the major participants in health care," including insurance companies, employers, legislators, hospital administrators and physicians. Patients and the media also play a role:

The public would gain the most from the diffusion of cost-effective care but often opposes reforms aimed at reducing health care spending because of misunderstanding about who really pays for health care. The media, with rare exceptions, is the principal source of this misunderstanding... Misleading headlines, designed to attract larger audiences, can make life difficult for physicians who want to practice cost-effective medicine but are beset by patients' requests or demands for costly new therapies: the public reflexively misunderstands any apparent withholding of widely touted diagnostic or therapeutic interventions, even when they might do more harm than good.

Hoping that the barriers won't "condemn the United States to financial Armageddon or diminished health care for less affluent Americans," Fuchs and Milstein present two possible solutions: tax-supported universal coverage and "managed competition among health insurers. But, they say, what happens next is up to physicians: The public trust in doctors makes them "the only plausible catalyst of policies to accelerate diffusion of cost-effective care."

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