NCPA - National Center for Policy Analysis


October 13, 2008

We are paying too much for medical care because the majority of doctors prefer to rely on their own clinical judgment instead of using proven treatments, say cardiologists George Diamond and Sanjay Kaul.

Consider treatment for coronary artery disease, the number one cause of death and disability in the United States.  There are two main ways to treat heart disease, say Diamond and Kaul:

  • Administering drugs to reduce pain and bring down the risk of having a heart attack; together they prolong life and improve quality of life for the patient.
  • Inserting tiny mesh tubes called stents to prop open coronary arteries, increasing blood flow and reducing pain.

Billions are spent each year on the latter procedure, which turns out not to work any better to prevent future heart attacks or prolong life than heart drugs alone.  Yet doctors prefer to use stents before even trying drugs.  Stenting costs thousands of dollars, while drug therapy alone costs a tenth as much, say Diamond and Kaul.

Insurance companies and the Medicare system could correct this overnight simply by deciding to pay more for care based on scientific evidence: 

  • A cardiologist who stents a patient who has already had drug therapy but failed to improve would be paid more than the customary fee.
  • A doctor who opts for the stent right away, without even trying drug therapy first, would be paid less. The precise amounts of these payments would be established--and published--by Medicare.
  • By discouraging inappropriate procedures and encouraging more appropriate alternatives, this evidence-based reimbursement strategy could save billions of dollars annually while simultaneously improving the overall quality of care.

A similar approach could target the handful of costly and frequently used high-tech procedures that account for most of the total cost of health care, conclude Diamond and Kaul.

Source: George A. Diamond and Sanjay Kaul, "Pay for Proof," Forbes, October 13, 2008.

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