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I've only consumed health care services in the USA. I am amazed at two things:
a) The average in the USA is about 4 visits to a doctor per year. That seems high to me.
b) In most other developed nations, people see the doctor much more -- 14 times per year in Japan. That's amazing to me.
Dartmouth research has found that patients with serious conditions who are treated in regions that provide the most aggressive medical care—more tests and procedures, more specialists, and more days in the hospital—don't live longer or enjoy a better quality of life than those who receive more conservative treatment.
Patients treated most aggressively are at increased risk of infections and medical errors that come from uncoordinated care, such as doctors prescribing drugs that duplicate or interact with other drugs. They also tend to receive poorer care, spend a lot more money for co-payments, and are the least satisfied with their health care, the Dartmouth researchers found.
What in God's name are these people doing going "to the doctor" 10 and 13 times per year?
It is likely enough that the importance of regular health care regimes will dawn on some people just after the point when it becomes obvious that it is too late to do so anymore.
The reality is that health care services are an economic good, and as with all economic goods, we need a system to efficiently allocate health care services.
Being faced with malpractice suits is not the reason doctors run so many tests. They run many tests because the cause of a patient's symptoms are numerous and varied, and they have to run a bunch of tests to pinpoint the cause, so they can choose the correct treatment. A lot of symptoms are quite vague, and unless the doctor runs tests, he has no clue what's causing it. Say a patient comes in complaining of fatigue and fever. There are 100 things that could cause it: the flu, a cold, a sinus infection, strep throat, ear infection, HIV infection, pneumonia, tuberculosis, measles, meningitis, diphtheria. It could even be the first symptom of cancer. So the doctor does a complete blood count, cultures, pathology testing, urine specimens, and maybe some other tests to determine exactly what it is before treating, so the patient can get better, than guess at what might be wrong, and treat the wrong illness numerous times.
That's all well and good, but a popular book I read that was authored by doctors said that some testing is done in part to avoid malpractice suits. From the gist of it and also consistent with my personal experiences, that's likely more of an issue within hospital systems.
Similarly, I think sometimes patients avoid emergency care because they know they will get huge bills, in part from possibly unnecessary tests.
That's an interesting chart. Factors that don't show in the chart are: patients in countries with free health care who go to the doctor simply out of loneliness or anxiety about potential illness; the story behind the low average in the US-- to what extent does it reflect the percentage of uninsured, who can't afford to go to the doc, and people who give up going to doctors because doctors ignore their legitimate concerns, vs. patients in middle age and beyond who tend to need more visits. A breakdown by age and gender would be interesting.
4 may seem high to a young, healthy person, but it's quite low to some of the 50+ women I know. And that includes people I've always considered to be healthy.
That's all well and good, but a popular book I read that was authored by doctors said that some testing is done in part to avoid malpractice suits.
Malpractice being a failure to provide the standard level of care. Taking your blood pressure as part of a routine physical exam is done in part to avoid malpractice suits.
Quote:
Originally Posted by goodheathen
From the gist of it and also consistent with my personal experiences, that's likely more of an issue within hospital systems. Similarly, I think sometimes patients avoid emergency care because they know they will get huge bills, in part from possibly unnecessary tests.
Doctors and hospitals need to diagnose the patients who present. Except in the context of an ER, no doctor will conduct a test without having first explained it and the purposes for it to you and obtained your consent.
That's an interesting chart. Factors that don't show in the chart are: patients in countries with free health care who go to the doctor simply out of loneliness or anxiety about potential illness; the story behind the low average in the US-- to what extent does it reflect the percentage of uninsured, who can't afford to go to the doc, and people who give up going to doctors because doctors ignore their legitimate concerns, vs. patients in middle age and beyond who tend to need more visits. A breakdown by age and gender would be interesting.
4 may seem high to a young, healthy person, but it's quite low to some of the 50+ women I know. And that includes people I've always considered to be healthy.
Malpractice being a failure to provide the standard level of care. Taking your blood pressure as part of a routine physical exam is done in part to avoid malpractice suits.
Somewhat misleading example, intentionally or not. I doubt blood pressure is a factor in many malpractice suits today. Standard of care in some situations leaves room for disagreement.
Quote:
Doctors and hospitals need to diagnose the patients who present. Except in the context of an ER, no doctor will conduct a test without having first explained it and the purposes for it to you and obtained your consent.
My personal experience is that doctors hardly explain unless asked. Consent for many or all exams that involve equipment needs to be in writing, but hardly anyone tells a doctor that he or she won't get a test the doctor is ordering.
I wish I remembered the name of the book. It has a section on how to better communicate symptoms and medical history, to be diagnosed more efficiently. Also, as the book says, doctors need to learn to rely less on formal tests to get to diagnosis. The crux of the health care cost issue really needs to be efficiency.
I have a very simple solution. Leave the traditional system in place for those with private insurance and medicare. However, a second system for those who have no money. Free clinic, free hospital, but its limited to how much the govt. can afford, so those patients will have to wait for some services.
Simple rarely works in the real world. I believe emergency care, which in most cases should not be delayed/skipped, makes up a large percentage of overall medical care costs. Furthermore, diagnosis for many seeming non-emergency problems should not be delayed, lest delayed treatment leads to worse outcomes (in health and/or costs) . In effect, delayed care becomes overtreatment. Also, people's financial situations can vary significantly within short periods of time
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