By John Espinola, M.D.
Executive Vice President, Health Care Services
Healthcare in the U.S. often fails to work for the person who needs it most - the patient. That's why, as I wrote in the previous blog post, the issues in healthcare 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. That includes simple and often inexpensive interventions like vaccines and cancer screenings. But another major problem in healthcare is that far too often patients get far more than they ever need.
This has consequences on both the patient and the overall healthcare system. For the system, an estimated 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 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. 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, they expose the patient to dangers that could easily be avoided.
For example, lower back pain is one of the most common conditions in the U.S. About 80 percent of Americans experience it at some point in their lives. Yet research suggests that nine times out of 10 surgery 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 explore 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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John Espinola, MD, MPH is Premera's Executive Vice President of Healthcare Services. He is also board certified in geriatrics and internal medicine. Read more about Dr. Espinola on our executive bios page.