There are very few standards applied in the United States relative to the comparative value or usefulness of each new device or approach. Any attempt to add evaluation processes into the current American economic model of health care technology or procedures is usually fiercely resisted by both the health care business units involved and by the American consumer.
Medicare failed miserably recently when it tried to require that the CT scans that are increasingly being used to find and diagnose nonsymptomatic heart disease should be substantiated and validated by some level of scientific evidence about the relative value of the scans. Medicare lost that battle hands down. Why did Medicare attempt to slow down the use of those scans?
The people at Medicare noticed that one of their fastest growing cost categories was CT scans that were being done simply to proactively "prospect" for possible heart damage or risk factors for basically nonsymptomatic Medicare patients. More than $14 billion worth of those screens were done in just one year and the number of scans being done was growing rapidly.
The Medicare leadership pointed out that there was no solid science showing any significant medical benefit from those purely "exploratory" scans. Ideally, doing a noninvasive scan that can be as accurate or more accurate than a truly physically invasive procedure is a good thing. In some cases, avoiding a physical probe or mechanical insertion and replacing it with a scan is a major improvement in patient care.
It's also true that the science of scanning is constantly improving, and the likelihood is high that scans will, at some point, replace even more instances of invasive cutting, probing, and testing.
That isn't the point of this example. The point is that for the heart scans being done, there was no in-place body of evidence showing that they added value. There was, however, a set of caregivers who profited significantly by doing those scans.
What was the result? The large number of American heart doctors who own their own CT machines and who now earn up to 60 percent of their personal revenue doing those particular scans played their own political cards with members of the U.S. Congress extremely well. In the end, Medicare simply surrendered, saying, very honestly, that these scans aren't the only thing Medicare pays for that isn't scientifically validated. Medicare was simply outgunned.
Many patients wanted those scans. Very successful ad campaigns have promoted the use of those scans. So the simple lack of science about the value of the scans didn't slow down the growth rate for the product or growth in the number of patients who were scanned.
Medicare is trying now to avoid paying for similar scans as an alternative to colonoscopies - hoping to wait until the technique proves itself before opening the door to millions of colon scans. The jury is still out on whether Medicare will be able to hold that particular line.
Our website is not responsible for the information contained by this article. Articleinput.com is a free articles resource thus practically any visitor can submit an article. However if you notice any copyrighted material, please contact us and we will remove the article(s) in discussion right away.
Note: This article was sent to us by: Alexander Chastens at 01032011
1. The real Medicare reform lies in the use of indemnities
All articles are property of their respective authors. Please read our Privacy Policy!
© 2009 ArticleInput.com.
Partners: Damenmode