08 February 2011

Assessing the Value of Medical Interventions

This article raises some very ethical questions and in addition may make some barriers to medical care rationing fall. There can be some very cost-effective medical interventions that are also thrown out. And if in the process, doctors consider that the cost-effectiveness is not applicable, what are we as patients to do?

It is true that our views as patients will vary and often differ from the medical professions perspective, but there needs to be a common ground that is not evidence-based (pure theory) in the decisions.

The American College of Physicians (ACP) published the guidelines in the February 1, 2011 issue of the Annals of Internal Medicine. They have outlined key steps to assess the value of medical interventions. Such measures could help to lower the cost of healthcare by eliminating low-value interventions and preserving high-value interventions. The challenge will be to decrease costs while preserving high-value, high-quality care.

Even they have concerns about restrictions on healthcare spending that will lead to more rationing, but they seem locked into cost-benefits analysis. What I get is that this analysis effort in itself can be expensive and is not always allowed in the expense of making the determination.

They have some examples which I am sure will meet with resistance, but much of this will probably be difficult to determine. Also the factor of third party intervention, that is the medical insurance industry, will they work with this and allow for some procedures that have high benefits at lower costs. We know that Medicare will not always be on board from some of their policies. See this about Medicare.

Not mentioned is preventive care which could have very high benefits and low cost. I am talking about screening for diabetes and working with these patients to delay the onset of full and costly diabetes. This may be part of the picture, but it is doubtful that the medical insurance industry will allow for this even though it could be very cost effective for them as well. Presently, it the diagnosis is prediabetes, there is no medical reimbursement. This needs to change as well.

Will the medical community work for these benefits? At present, this seems very doubtful, even if there is a lot of call for this.

Read the article in full here.

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