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Doctors: It's Our Job to Profit, Not Lower Health Care Costs


On Tuesday the Journal of American Medicine published the results of a survey asking doctors which actors in the health care system are most responsible for reducing costs. WaPo reports on the surprising findings:

Based on their findings, 59 percent of doctors believed they have some responsibility in holding down health care costs. Only 36 percent thought they have a major role.

More than half of doctors, however, said each of five other groups carry “major responsibility:” trial lawyers, health insurance companies, pharmaceutical companies, hospitals and patients.

“What physicians are trying to tell us is that they don’t see themselves as necessarily any more responsible for health care costs than all of those stakeholders,” said Dr. Jon Tilburt, an associate professor at the Mayo Clinic and the study’s lead author.

The key group here is “patients.” Doctors are certainly right to suggest that a more consumer-driven system could do much to improve quality and drive down costs. But they seem overlook the fact that the current system, based on fee-for-service payments, is stacked in favor of the doctors. Health care can probably never be a fully level playing field. But if patients could inform themselves about prices before going through with various tests and treatments, they could contribute to lowering costs by opting out of unnecessary or overly expensive ones.

We favor reforms that will allow that to happen. In the meantime, doctors ought to own up to the part they play in ratcheting up costs throughout the health care system. Given this survey’s rather damning finding that only one in nine doctors “said they need to take ‘a more prominent role’ in limiting unnecessary tests,” however, it looks like they won’t be coming clean anytime soon.

[Surgeon image courtesy of Shutterstock]

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  • Andrew Allison

    Not up to VM standards. It’s well documented that doctors order unnecessary procedures to protect themselves from the trial bar, and that processing insurance claims probably costs more than malpractice insurance. As VM has recently reported, doctors who decline health insurance can halve their charges. Doesn’t this strongly suggests where the excessive costs lie?

  • Boritz

    I agree with Andrew. WRM just what do you mean by ‘unnecessary’? This practice of ordering extra tests is called defensive medicine. Defense is what you do in response to the actions of others. In the context of the legal environment these tests are a necessity for a medical practitioner who wants to keep his office door open. So to tackle the issue of how could doctors take “a more prominent role in limiting unnecessary tests” let’s consider the Netherlands. How could this country take a more prominent role is reducing their decidedly defensive reliance on sea walls to keep the sea out of their (below sea level) country? Well, if the sea would be more reasonable perhaps an equitable and common sense agreement could be reached, but I suspect a ‘damning’ percentage of Dutch people would want to keep this measure in place.

  • MontyBurnz

    Walter your dem stripes are showing. My job as a doctor is to take care of patients, not to be nickel and diming them on the tests I order in order to save the system money. Yes ,we should not order extraneous tests but many times its cya and many other times its best for the patient.

    With the cost of going to medical school climbing and climbing, cutting down on doctor profits will just exacerbate the lack of access to docs as smart people choose other, easier, less expensive and more lucrative jobs and professions.

  • Bruno_Behrend

    Did the survey actually say “patients” anywhere on the responsibility question? If not, it’s a worthless survey.

    Every healthcare provider should put up a price list of every item they charge for. Patients should be incentivised to save money by shopping for the best price and record (yes, ratings and suits need to be made public)

    We have a horrific opaque system where no one wants to tell the you price or cost.

    This is the downfall of 3rd and single payer systems. There is no price pressure, and no transparency.

    All of that said, the worst culprits in the system are hospitals and insurance administration. Like unionized teachers, doctors bear some responsibility for the mess, but get points for being the people in the system who actually do something.

  • ljgude

    Well, I think there is an overlooked issue here. Doctors have historically not been uniformly gougers – anyone old enough to remember will recall the country doctors of 50s who treated all comers and didn’t press for payment. I live in Perth Western Australia and am going to have a heart procedure next month. I am privately insured and the surgeon told me when preparing me for the operation that it would not cost me anything even a co-pay for the anesthetist.. He said he simply had the policy that he would only work with anesthetists who did not charge over the scheduled fee! I know from other experiences that the old medical ethos of going easy on pensioners like myself is not dead. I know the US healthcare environment is different but I think you would find a lot of doctors, as opposed to the other stakeholders mentioned, who would be less than predatory in their charging policies. There is a simple reason I think. And that is that medicine is a helping profession and that people go into it for altruistic reasons as well as for making a good living or profit.

  • Astrocanis

    In addition to the aforementioned (Andrew Allison), with plentiful money available, the costs to educate a new physician have skyrocketed, putting new doctors at financial risk and REQUIRING that they charge certain fees. Another case of governmental interference and the law of unintended consequences.

    I liken this to the importation of predators to Australia: it was done with the best of intentions and now it’s completely out of hand.

  • Jeff W.

    There could be a level playing field in the medical marketplace if patients would buy medical services through agents.

    Agents who were well informed about prices and service quality, who were healthy and whose financial interests were aligned with those of the patients, could do a good job of negotiating.

    In today’s world, patients usually cannot even begin to negotiate or shop. They just get steamrollered by the system.

  • DavidM

    I think its funny that consumers want to save as much of their money as possible thats OK, but when doctors want to earn as much as possible its considered greedy.

  • rheddles

    The problem with the constantly escalating costs of higher education is the high wages paid professors and the unnecessary courses they require just to pad tuition payments. Professors need to take a more prominent role in limiting the excessive increases in tuition.

  • holygoat

    “But they seem overlook the fact that the current system, based on fee-for-service payments, is stacked in favor of the doctors.”

    I wonder if the unique skill set that doctors possess might have somethig to do with that?

    “Health care can probably never be a fully level playing field. But if patients could inform themselves about prices before going through with various tests and treatments, they could contribute to lowering costs by opting out of unnecessary or overly expensive ones.”

    I wonder if the fake market created by the assumption that employers should provide health insurance and the inability to fully collect on many procedures from Medicare (and soon to be Obamacare) might have something to do with that?

    If patients actually had to cut the check for medical procedures rather than simply hand over an insurance card with the expectation that everything will be covered, regardless of costs, you’d likely see the kind of opting out of costly tests and treatments that would effect overall health care spending.

  • William Knabe

    I am in a service business. My “responsibility” is to provide a service to my clients and my client’s “responsibility” is to compensate me. It’s a trade. If the client determines my service is less valuable then what I am charging he goes somewhere else, or doesn’t buy the service. If I determine my services are worth more than what customers are willing to pay I find something else of withhold my service.

    Why is medicine any different? Why do we act like medicine can’t be subject to the same market forces, that have led in every instance where they are tried, to lower prices, greater choice and a healthy dynamic market?

  • Scott Kirwin

    Professor Mead seems to have it in for doctors these days. The current system is stacked in favor of the doctors? Has someone been partaking in Stately Mead Manor? See this counterpoint from the doctor’s perspective (through her husband) here:

  • William D Charschan

    The problem also is that often, a doctor will suggest a test as preventative, when they find something that is inconclusive as happened to me during a colonoscopy. As I walked out, they suggested they wanted me to have an additional test to rule out some other unthinkable disease processes. The colonoscopy was negative and so was the other test, which hit my deductible and I am out $1500 dollars for a pelvic MRI which was of course also negative.
    What if diseases are a very powerful motivator which plays the back door fear card. In the US, we have been conditioned to believe as patients all this is necessary. Well, if you look at our health record here, we are worse off and of course poorer due to the unnecessary ordering of tests like these.
    Perhaps a better course of followup may have been lets watch this and see if you develop such and such symptoms. If you do, then perhaps we should order such and such.
    Multiple this by millions of tests, and of course no logical idea of what these tests really should cost, and the patient as a consumer is screwed. The doctors are a huge player in what drives health costs due to their own medical dogma or belief systems.

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