As a hospitalist, I have witnessed a steady stream of regulations from both private and federal insurance agencies, designed to reduce the cost of healthcare. Payment limitations or outright denials, based on admission status, coding accuracy, readmission rates and other parameters have created a costly army of bureaucrats at every medical institution, charged with insuring that all regulations are enforced. In the end, little is achieved and the cost of healthcare continues to rise.
The only interventions that will truly make an impact on healthcare costs are an aggressive approach to preventive health and a strict adherence to evidence-based, cost-effective medicine, eliminating payment for costly drugs and procedures that have no proven benefit. When it comes to prevention, vaccinations are paramount in children while healthy lifestyle choices are vital in all age groups. The combined effect of tobacco, obesity and alcohol abuse is responsible for a large percentage of health care costs and we all end up paying for those conditions. Unfortunately, financial incentives tend to be more effective than public education and every effort must be made to augment the personal cost of unhealthy lifesytle choices, including high taxes on the items of abuse and higher insurance rates for those who assume those risks. As with many social problems, an attack on poor and costly lifestyle choices must begin during childhood and some traction has been achieved via healthy lunch menus and exercise programs in grade schools across our country. While cynics might dismiss such efforts, a failure to instill healthy behavior in children will, in the long run, impose a high cost on society.
When it comes to evidence-based, cost-effective care, we must accept the fact that some rationing of resources is essential. The use of intensive care units for end of life care is perhaps the most egregious example of misspent funds but the rush toward surgical management of obesity is rapidly climbing the list. Commercial advertising of prescription medications, now out of control, not only adds to the cost of those medications but fosters the mentality that drugs are the answer to all human maladies; in fact, side effects from these agents account for a significant amount of morbidity and mortality, further adding to the cost of healthcare. Finally, the pressure of litigation must be removed from the equation; when standard of care is delivered, adhering to evidence-based, cost effective measures, physicians should not be held accountable for bad outcomes which, inevitably, will occur.
