The Four Problems of Healthcare: I Often Get What I Don't Need

By Dr. John Espinola
Tuesday, November 07, 2017
Male Doctor In Office

Health care in the U.S. often fails to work for the person it most needs to work for - the patient. That's why, as I wrote in the previous blog post, the issues in health care boil down to four basic problems:  

  • It costs too much.

  • I don't get what I need.

  • I often get what I don't need.

  • I don't like the experience I have.

We've discussed two so far.  Now we address the other pair.   

I often get what I don't need  

We wrote last about patients failing to get the kind of care they need, such as simple and often inexpensive interventions like vaccines and cancer screenings. But another major problem in health care is that far too often patients get far more than they ever need.

This has consequences on both the patient and the overall health care system. For the system, it's estimated by the Dartmouth Institute for Health Policy and Clinical Practice that 30 percent of Medicare clinical care spending is unnecessary or harmful. In 2012, former Medicare chief Dr. Don Berwick and RAND Corp. fellow Andrew Hackbarth wrote that 20 percent of all health care spending could be linked to some key areas of waste, the biggest of which was spending too much on care that isn't proven to be effective, or costs more than cheaper-but-as-effective options.  

This kind of over-servicing has real life ramifications. It is like if you go into a hardware store for a rake because there are too many leaves in your backyard, but you come out with a leaf blower (so much more powerful!), a chain saw (cut the tree down and never have the problem again!) and a chaise lounge (ignore the leaves, sit back in your yard and relax!) That hardware store made your life worse, not better, didn't it?   

Of course, we're not talking about a hardware store. We're talking about someone's health. And we have to remember that no health care intervention is risk-free, so when a provider does something that isn't really necessary, his or her patient is exposed to dangers that could easily be avoided.

For example, lower back pain is one of the most common conditions in the U.S., experienced by 80 percent of Americans at some point in their lives. Yet when surgery is the solution, research suggests that nine times out of 10 it is unnecessary or ineffective. The risks of this surgery include stroke, heart attack, infection, blood clots in the lung and even death. I don't know about you, but if I'm going to expose myself or my loved ones to those risks, I want to know the surgery is going to work and is something I truly need.

Long scholarly articles and books have been written about this problem of over-testing and over-use of some services. It is a huge problem in the U.S and it makes healthcare much more expensive than it should be. In future posts, we will write about what Premera is doing to reduce duplication of testing and to reduce or eliminate unnecessary or unproductive procedures.


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