By Janet Fang
Posting in Education
Turns out, the growth of advanced imaging has slowed amid financial concerns, a new study shows.
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
Jul 30, 2012
Q: What's driving health care costs? This one is easy... A: Someone else is paying the bill. When you go to the doctor and only pay
If a criminal holds us hostage, threatening or well being and or lives in exchange for money we call it "extortion." When the insurance/medical industries do it, we call it "capitalism." Once your your life can be equated with your ability to pay - you're not only extorted, you're screwed.
Given that healthcare in Europe, specifically in the northern countries is less expensive and people live longer and are healthier (healthcare is more effective there), this whole discussion is unimportant.
In addition to the blindness to cost-benefit that previous posters stated, I see two huge cost drivers: defensive medicine and administration. Defensive medicine, that is, the doctor's efforts to avoid a lawsuit or win it, drives the orders for additional tests and procedures. That way the doctor can demonstrate that he/she did everything in the known universe to treat the patient (instead of using good judgment and experience to treat what's wrong). Administration is the excessive recordkeeping and forms-filling that is required by the insurance companies and regulators. Administrative costs could be reduced by asking each question and entering the answer only once, and then using that information to complete a much-reduced set of forms and reports. Some doctors avoid doing private practice because they don't want to spend their evenings filling out the endless forms, and can't afford to hire an insurance administrator to do them. Both of these problems can be fixed not with more legislation, but by less. Reduce the regulatory requirement for reporting, and rely instead on monitoring doctors' and hospitals' performance results to judge quality and prevent fraud. Provide tax and reporting incentives for reducing insurance paperwork, and make minimalist paperwork a condition for licensing of insurance companies. And most important, implement much-discussed tort reform, to confine lawsuits to genuine malpractice instances. Implement the above, and watch health care costs shrink. Too much of the money is going to strap-hangers, and not enough to the essential providers. Only activist citizens, not accessible by special interests, can make this happen.
In recent years efforts to support the International Space Station have included medical research into using compact ultrasound technology for diagnostics in place of MRIs, CAT scans and the like not available in space. This research has already created diagnostic techniques that would be invaluable in rural or poor areas of the world where high end technology is not available. They also offer a cost effective alternative for some. Sadly much of it is hung up in bureaucratic paperwork and certification testing that may take years to satisfy government regulators. These tools will never fully replace MRIs and CAT scans, but there are many doctors who feel that ultra sound tests would be better than the nothing many patients receive now because of insurance coverage gaps. Many also feel they can be a cost effective alternative for at least half of all ROUTINE procedures. The real holdup are the companies and doctors who have huge dollars tied up in expensive equipment and training that fear they will become mostly obsolete once these affordable techniques are widely available. They will not be obsolete, but fear is an irrational beast.
What is needed is to have the majority of expenses/charges made visible and public so that there is a reasonable idea as to the actual costs involved. If there is enough of difference a person could go to one provider for one series of tests and another for analysis of the results. The only reason to hide this information is to allow someone to pad their profits.
It's because "health care" is one of the few things we buy where we don't care what it costs when we need it, and then negotiate the price to be paid after the fact.
But the back end of things. I wouldn't be surprised if most of insurers and hospital billing systems are on XP or earlier, stuck on IE6, with limited ability to cross-communicate via the cloud.
...that too many people have confused "insurance" with what they really want, which is a "payment plan". And even then, they wish it structured so that they never really know what they're really paying, and even then fool themselves into believing that someone else (employer or government) is paying for it.
If it's capitalism, then it means that you contracted with a lousy insurance company, if you bothered to at all. It's hardly "extortion".
...but that people in many countries tend to live heather lives. (Mainly due to diet) Survival rates for most diseases (especially cancer) is actually much higher in America, suggesting that heath care is actually more effective here.
the free market doesn't work with health care. If a person is seriously ill that person has no regards for the cost. "Just make me better." This is in answer to richard233 as well. There's no real competiton when nobody is comparing.
Illegal immigration...in Denver alone, Denver Health and CU Medical Center lost in a year around 128 M dollars on unpaid, federally required health care - a great deal of it in maternity costs. They have to roll that back in somewhere!
...but the rest of the system shouldn't. The problem is that most people do not have a clue as to what they are actually spending on non-emergency health care and they should. What's even worse, is that since these costs are kept opaque, they either don't care or don't really want to know. Many are happy thinking that someone else is paying for them. So why should they wish to compare?
...since so many of those same immigrants are entitled to "free" health care in their home countries. Makes one wonder why they come here.