Exploding health care costs are not caused by cutting-edge medical technology. MIT News explains why.
Amid financial concerns, the growth of medical imaging has slowed. This is surprising since sophisticated technology -- like computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) -- is often cited as the leading driver of medical costs, since their increasing availability appeared to make treatments more expensive.
MIT economist Frank Levy and David Lee of GE Healthcare suggest that a more selective use of high-end imaging is advancing within the medical profession.
Combining statistics for government-backed systems with data from commercial insurers, they showed that -- after a rapid expansion in advanced medical imaging -- the use of technologies slowed through 2009. This was the case for Medicare recipients as well as patients enrolled in employer-sponsored health plans.
- From 2000 through 2005, use of CT scans among Medicare recipients (aged 55 and older) grew by an annual average of 14.3 percent, but that growth then declined every year after 2005, falling to 7.1 percent in 2006 and 1.4 percent in 2009.
- Among Medicare enrollees, the number of MRI exams increased by 14 percent from 2000 through 2005, but only grew by 2.6 percent during the 2006 to 2009 period.
- Among a sample of 1.1 million non-elderly, commercially insured people in the study, the number of CT scans performed on patients increased by 20.4 percent from 2002 to 2006, but by just 3.1 percent from 2006 to 2009.
- About half of the slowdown in MRI imaging involved diagnoses of back, elbow, and knee problems -- with doctors opting for more conservative treatments to deal with temporary injuries.
- There are increased concerns about the exposure to radiation involved in CT and PET tests.
- But the main reason growth slowed is because of new insurance arrangements. These include larger deductibles: the percentage of employees with a deductible of at least $1,000 grew from 10 percent in 2006 to 27 percent in 2010.
- Also, there’s an increased use of ‘prior authorization’ in insurance, which requires doctors to conform to guidelines about the appropriateness of medical treatments.
- Congress’ 2005 Deficit Reduction Act reduced reimbursements for imaging performed in physicians’ offices, reducing the incentives for doctors to acquire machines for their own offices and then use them frequently to pay for that initial investment.
“Eight or nine years ago, the atmosphere [in clinics and hospitals] was that if you’re not doing a scan, you’re not doing modern medicine,” Levy says. “Now… there’s more consideration about whether patients really need a scan or not.”
The work was published in Health Affairs.
[Via MIT News]
Image: CT scan slices / Mayo Foundation for Medical Education and Research