Quit Wasting My Healthcare

The Doctor is In: Cardiac CT Scans in the New York Times

The lead article in the Sunday New York Times on June 29^th was on the high cost ($1,000 per scan) and questionable efficacy of cardiac CT scans that can visualize the coronary arteries of the heart.  However, the article goes on to quote cardiologists and other experts on both sides of the argument of whether or not cardiac CT scans are actually helpful in the majority of situations where they are being used.

So what should I as a physician, patients and payers of medical care (the government, insurance companies, employers) do when a test of questionable use—as in cardiac CT scans—becomes relatively commonplace?  Who should be responsible for paying?  The doctor?  The patient?  The government or insurance company?

Any broad, sweeping policy decision by the government or insurance industry is a very blunt instrument for addressing these difficult questions.  Ultimately, the decision needs to be made together by the patient and their physician with cost being a part of the decision making process.  Co-insurance (where the patient pays a percentage of the total cost of the test) is an effective way to bring cost into that discussion.

While every insurance policy should have an out-of-pocket maximum to prevent financial ruin for the patient, the days of blank-check medicine are and should be over.  As in the case of cardiac CTs, maybe a patient should pay $200 of the $1,000 cost so that before the test is performed the patient can ask, “Doc, do I really need this?  Is there something else we can do?”  When patients have to start paying for a portion of medical services themselves, they will be begin to press me as a physician to be a better steward of healthcare resources without sacrificing quality–I know I can do that in many instances–using generics, checking with guidelines before ordering expensive tests.  Maybe patients will also start pressing the government and insurance companies to sponsor the kind of comparative, cost-effectiveness trials that experts from every side of healthcare have been calling for for years.