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HEALTH POLITICS: It's the Other Guy Getting the Unnecessary Care

You know all those polls that show Americans distrust Congress—but like their own Congressman (or woman)? Well, here's the health care corollary. About half of Americans now believe that people get unnecessary tests and treatments. But—yep, you guessed it—the tests and treatments they themselves get aren't unnecessary.

Half of those surveyed said we have a "major problem" with unnecessary tests and treatments, and two-thirds said too many patients are "not getting medical tests and treatments they need." But only 16 percent thought they had ever received any unnecessary care. Guess it's the Dartmouth Atlas equivalent of NIMBY.



That's just one of the findings of the latest Kaiser Family Foundation poll (this time with NPR) on the public views on health care reform. The poll asked very specific questions about issues that are under discussion in Washington, or were already passed into law as part of the economic stimulus package. Here are some highlights:

  • Three out of four Americans favor having health care providers use electronic medical records, and many perceived the benefits in terms of care coordination, quality, and preventing medical errors. But most didn't think it would save money and more than half worried about privacy breaches.
  • Half the public said care coordination wasn't a personal problem for them, but 44 percent, a significant minority, did report at least some difficulty in coordinating care between different doctors. As one would expect, those who see more doctors report experiencing more coordination of care challenges. (This wasn't part of the poll, but if you talk to patients, or families of patients, who have ongoing serious chronic health challenges, with multiple doctors, you'll hear an earful about care coordination problems.)
  • Only about one in five of those surveyed has asked about the costs of medical or lab tests they have received in the past two years (though one in three uninsured people asked). In fact, 37 percent said they didn't think their doctor even knew how much a test cost. The results were a bit different when it came to treatment, rather than diagnostics. Nearly half (46 percent), had talked to a doctor about how a treatment's effectiveness compared to less expensive alternatives.
  • On the comparative effectiveness front, seven in 10 of those surveyed believe we don't always have clear scientific evidence about which treatment is likely to work best for a specific patient. But they are very wary about letting government agencies, independent scientific bodies, or insurers make decisions about which tests and treatments should be covered by insurance. For example, less than half (41 percent) would trust experts from an independent scientific organization appointed by the federal government "a great deal" or "a fair amount" to make such a recommendation. Slightly more than half thought that insurers should have to pay for a costly treatment even if it had not been shown to be the most effective.

As earlier Kaiser surveys have shown again and again, the rising cost of health care is a burden, even for the insured. One in four reported that someone in their household had problems paying medical bills over the past year, and 45 percent have taken some kind of action to reduce cost. A third skipped dental care, one in five didn't fill a prescription, and one in five skipped a test or treatment. The burden naturally is higher on the uninsured.

One last nonsurprise: people don't want to spend a lot of money to fix the problem. More than 90 percent of the uninsured would willingly pay $25 a month for coverage, but only 64 percent were willing to pay $100, 29 percent $200, and just six percent $400.

Too Many Tests, No Analysis, No Diagnosis or Treatment

My blog, is a chronological portrayal of my many doctor visits from 2003 on that culminated in my becoming disabled. Doctors did nothing more than accumulate metrics and refer me to other doctors because none wanted to take the time to analyze positive test results in order to make a meaningful diagnosis. Some doctors got caught up in "doctoring" their diagnosis for insurance purposes and forgot I was really ill and needed treatment. Many tests were repeated even though the last test was just completed the month or two before. It seemed each doctor only wanted to review his own test results. I never got treated or properly diagnosed. I was referred to dozens of physicians who each found something wrong with me in another doctor's specialty. I ended up with three 3-ring binders of tests documenting my systemic infections that caused severe degeneration of my spine. I am now on Social Security Disability. Those doctors had no difficulty arriving at a diagnosis from my wealth of accumulated test results because they read them. The experience left me broke, facing foreclosure in very bad health, and still with no medical care. I have no family and no where to go. Too many tests and not enough time analyzing results. To me, this amounts to torture and no one cares.

What about provider payment?

I found it interesting that the public (as described in this survey) seems to favor continuing the fee-for-service style of paying doctors even though few in academia or the think-tank world share this viewpoint. A small minority (about 25 percent) favor prospective payment or the capitation/salary philosophy seen in HMOs. In this survey, there were no questions about pay-for-performance. It would be interesting in future polls to see the public opinion on P4P.