Arnold Kling  

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The New York Times reports,


more than 1,000 other cardiologists and hospitals have installed CT scanners like the one Dr. Rosenblatt turned down. Many are promoting heart scans to patients with radio, Internet and newspaper ads. Time magazine and Oprah Winfrey have also extolled the scans, which were given to more than 150,000 people in this country last year at a cost exceeding $100 million. Their use is expected to soar through the next decade. But there is scant evidence that the scans benefit most patients.

The story could be straight out of my book.

The Times falsely says that "At a time when Americans are being forced to pay a growing share of their medical bills..."

If only. What the story misses, and what my book emphasizes, is that these expensive, discretionary medical procedures are spurred by insulating the consumer from the cost, thanks to what we call "insurance."

Thanks to Peter Orszag for the pointer.


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COMMENTS (8 to date)

Why do health plans pay for this sort of thing if there's little evidence to show it benefits patients? Wouldn't employers prefer plans that were cheaper but paid for evidence-based care?

Finja writes:

"insulating the consumer from the costs" - what exactly do you mean?
if the consumer knew the costs of the procedure, or if he actually had to pay for it?

Rationalitate writes:

Your tinyurl link is broken. And, for the future, what's the point in using it? For one, it makes it look like you're trying to surreptitiously link to a porn site (making goatse.cx links look legitimate used to be a big game on Slashdot, which is why I'm wary of tinyurl links). Secondly, it makes it look like you're trying to hide the fact that you're getting the referral bonus that's probably tacked on the end of that Amazon link. ;-)

Arnold Kling writes:

link fixed. sorry, I typed 83 instead of 8e

M. Hodak writes:

I think "forced" is the operative word in this NYT rendition of the fallacy. We're forced to pay for unnecessary procedures only in the sense that insurers are forced to pay for these procedures because of regulatory compulsion, or the economics of liability, both which are policy incentives at work here.

Dr. T writes:

The NY Times is not mistaken about the general public being forced to pay for unneeded procedures. New York state heavily regulates health insurance companies and requires them to pay for many procedures that the insurers believe are unneeded. The same is true with Medicare: if a procedure is accepted (perhaps, originally, for special circumstances) it rapidly becomes a mainstream procedure. Twenty years ago, echocardiograms were rare. Now, they are old hat. Five years ago, no one used CT scans for routine heart evaluation. Now, more than 150,000 heart CTs have been done. This procedure wouldn't even exist if patients paid for routine medical care out-of-pocket. A cardiologist would have to do a lot of explaining before a patient would shell out $800 for a heart CT scan, especially after already paying $800 for a physical exam, EKG, stress test, and an assortment of lab tests. It's much easier to get patient consent when a third party covers 80-100% of the cost.

Bob writes:

Arnold, you should reject the NYT's idea that Americans are paying a growing share of their health care at a more basic level - Americans as a group have always paid for roughly 100% of Americans as a group's health care. Who else would be paying for it?

Even more than insulation at the patient level, the idea that gov care is somehow "free" healthcare needs to be put to rest.

Andrew Whitman writes:

What struck me in The New York Times article “Weighing the Costs of a CT Scan Inside the Heart” was what the story omitted: peer-reviewed and emerging clinical trial data showing that CTA scans produce cost savings and improve patient outcomes. Also, for a story of this length to leave out any discussion of appropriateness criteria – even though cardiology and radiology medical societies already have programs in place, and both criteria are part of the current policy discussion – is curious. In my estimation, it fails to offer readers balanced information to help inform their decisions.

There are numerous peer-reviewed studies demonstrating that CT scans detect heart disease and help patients avoid cardiac catheterization. For example, the article could have cited a 2007 study in the Journal of the American College of Cardiology, which found that multi-slice heart scans significantly reduced diagnostic time and produced cost savings. It could have also cited a recent study demonstrating how CT heart scans are an effective and cost-saving tool in selecting patients for cardiac catheterization. The selective catheterization resulted in average cost savings of $1,454 per patient.

Proper utilization of any medical technology is important, and the majority of doctors do use medical imaging appropriately, without standing to realize any financial gain from doing so. In fact, according to 2005 Medicare claims data, an average of 94% of CT, MRI, PET and SPECT referrals are made to physicians who do not order the tests, and that percentage is even higher for cardiac imaging. To address the small minority of instances when imaging is improperly used, policymakers and medical societies are embracing appropriateness criteria and accreditation requirements as effective solutions that allow health decisions to remain in the domain of physicians and patients rather than insurance companies. Unfortunately, The Times story made no mention of this either.

CT heart scans eliminate the need for an invasive and expensive procedure to diagnose coronary artery disease by providing precise and comprehensive information on heart ailments without surgery and within seconds. Yes, a CT heart scan may seem expensive when viewed in isolation, but compare the price tag of a one time scan to the cumulative, long-term costs that will come with its regrettable alternatives: repetitive consultation and progression of disease and inappropriate treatment. Talk about penny wise and pound foolish—especially considering that coronary artery disease is the most common type of heart disease, and the number one killer for both men and women.

Thankfully, Medicare’s recent heart CT scan coverage decision allowed continued patient access to these tremendously valuable scans, which have revolutionized the way doctors diagnose heart disease, and become the standard of care for cardiac disease throughout the country and the world. I am certain that patients across America are benefiting as a result, and in this vein, it is incumbent upon us and our healthcare system to ensure that physicians are continually armed with improved resources for diagnosing and treating disease more precisely, effectively and efficiently – not restricted in their ability to save lives.

Andrew Whitman
Vice President, Medical Imaging & Technology Alliance
http://www.medicalimaging.org/

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