Is Using Health Resources Less Expensively "Rationing?"

Critics of the Democrats' health care overhaul effort see veiled "rationing" schemes behind plans to curb misused and overused tests, treatments and drugs that drive up medical costs without helping patients, The Washington Post reports. "Others, however, see problems of misalignment in the American system, fueled by industry advertising, physician fears about malpractice lawsuits and a culture that craves the latest, greatest everything. The situation here, they argue, is that there is not enough care for some, and too much for others."

For example, people with generous health coverage may opt to receive a back surgery, and then end up with even more expensive complications from the procedure, all for a condition that may be more effectively treated with physical therapy. That, along with heavy prescribing habits, overuse of scans and other costly medical habits illustrate a 'more-is-better' culture. "In many cases, less is better," one expert tells the Post (Connolly, 9/29).

Dallas health providers are leading specimens of that more-is-better medical mentality, The Dallas Morning News reports. "[S]pecialists aren't paid unless they see patients. Primary care doctors are harried and in short supply. Some doctors invest in hospitals and imaging centers." But in Temple, Texas, a 2-hour drive away, one physician-operated provider, Scott & White Healthcare, is achieving some of the best outcomes in the country at below average costs.

"In Temple and some other communities across the nation, payment incentives for medical providers promote cost efficiency," the paper reports. Doctors are paid salaries, as well as bonuses for healthy patients; the hospital cuts costs by maintaining a humble, but effective, facility; doctors across different specialties coordinate care with help from computers. "Success in holding the line on health care costs starts with a desire to do it" (Garrett and Landers, 9/28).

Another idea to improve the quality, value and effectiveness of health care is a controversial type of research that compares treatments head-to-head, USA Today reports. "As part of the effort to change the nation's $2.6 trillion health care system, President Obama has proposed expanding comparative effectiveness research as a way to lower costs. The idea has prompted warnings from Conservatives for Patients' Rights and other conservative groups that say it could lead to rationing of care."

But, many health care companies, including Kaiser Permanente, are already employing comparative effectiveness research.  Kaiser has analyzed more than 75,000 joint-replacement surgeries and doctors use the data to guide patients to procedures that will be most effective for their conditions. The data show, for instance, that regular cement works better than hybrid cement for holding joint impants in place, even though some manufacturers push the hybrid product (Fritze, 9/29).

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