The elephant in the room

A somewhat lengthy reflection on some of the drivers of healthcare costs, particularly the incentive systems and the lack of consistency among practitioners. Well worth reading for those interested in health policy. Article ends up with some good questions for the medical profession and policy makers:

  • The key question is ‘How should healthcare decisions be made?’ Or rather, ‘How do we spend the healthcare budget?’
  • Are there treatments we all agree deliver value for money to our patients?
  • Are there specific treatments that we all agree are poor value?
  • Should the medical profession as a whole take responsibility for treatment decisions that most of us consider to be wrong? Personally I consider that we should. We are best placed to understand and advise on the issues, and the public looks to us to provide the best possible care and dispassionate advice.
  • Would any doctor who took on this battle be prepared for the inevitable media backlash when disgruntled colleagues (and angry patients) discover they are on the losing end of the process? This might be the biggest stumbling block.

There have been some efforts in the US to establish guidelines (see Doctors call for end to five cancer tests, treatments), and public healthcare systems do tend to have these kind of review processes, imperfect as they are.

The elephant in the room.

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