The Demand Side of Healthcare Reform

I just couldn't help but respond to this video blog and resultant poll from Medscape. Dr. Henry Black talks about the "Demand Side of Healthcare" or when a patient sees an ad on TV or magazine, read on the internet, etc about a new test or treatment. They then come to their health professional with this information and "demand" to have this treatment, test or what have you. Since most physicians do not have the time or resources to continually explain why they do not need that test, they cave in and order it. Dr. Black believes this is another aspect that has contributed to increased healthcare costs. He further states that he had not heard this aspect addressed in the reform "talk". The subsequnt Medscape poll did demonstrate by and large the majority of healthcare professionals either strongly agree or somewhat agree that this is the case.

What was most interesting to me was that the physician group of voters had a higher percent of votes in the "Somewhat Agree" while other professionals had the highest percentage in the "Strongly Agree" voting pool. Is it a difference of those of us who are not physicians having a false perception of reality or the physicians unwilling to admit that they succumb to the pressure? Which case is correct is probably irrelevant since most all professionals agree this to be the case. From my perspective...I certainly believe that to be the case and have seen it happen for years. I do believe it has contributed to rising costs and could be included in part to the practice of defensive medicine.

I first recall this being an issue many years ago with the debate over doing a csection vs a vaginal delivery. It was thought at the time (and still today) that the increasing frequency of csection deliveries was due to consumer demand AND convenience for the physician and consumer. Afterall, when you can schedule the delivery of your baby there is much less interruption in your life...you can plan around it. The physician can also plan it at a more convenient time than in the middle of the night...why not? Of course, having a csection is a greater expense on resources (thus increased cost) and carries a greater risk of complications.

I could go on and on about the continuing debate related to "birthing a baby" but the point is greater than this one example. Throughout the years we have seen higher prescription orders for new drugs or newly "advertised" drugs...thought to be directly attributable to consumer demand after seeing the advertisements or before that, directly attributable to physician's responses to pharmaceutical reps visiting and gifting. It is a big game and we are all losing.

The point to all this is: until WE the consumer and WE the healthcare professionals agree and follow accepted standards of care, we will always be losing in this game. This has been partially addressed in the here-to-fore presented platforms for reform i.e. The Mayo Clinic Experience. For conditions in which we do not have evidence of the most cost effective and highest quality of care, we need to establish that evidence. For conditions in which we do have sufficient evidence for determining the best quality of care (and therefore most cost effective) we should use them. Staying informed and even questioning our physicians is our right and perhaps a responsibility. However, our relationship with our healthcare provider should be a partnership in which we discuss and agree upon the best treatment plan...we should not have to "demand" it...it should be a given. And just because we see it on TV, does not make it so.

This area should be elevated in scope as a major spoke in the healthcare reform wheel. It has been mentioned but not emphasized enough. I invite your comments, agreements and disagreements.

Medication: Get 2 for the Price of 1

The following tip may be useful for some people with a portion of your medications. Let me first put out a disclaimer that to use this method, the individual must be mentally, physically and emotionally capable of carrying out the task correctly. Always use your physician's advice in the use of any of your medications. Having said this, let me describe this potential option. It may be applicable with some of the more expensive medications that are very limited in the amount that can be received in a month time. This is the case whether you have insurance or pay out of pocket for your meds.

Many medications can safely be cut in half. These medications are generally in a pill form rather than a capsule. Never try to half a capsule or a coated tablet...these pills are designed so that the effectiveness of the drug is dependent upon the particular coating of form. Ask your doctor if any of your medications are appropriate to try this method. Never reduce your prescribed medication dose without the advice of your physician, especially in order to save money.

To explain what I am trying to convey, I will use an example...Imitrex (a common pill used to abort migraine headaches). This medication comes in packets of 9 pills...you cannot get more in one month whether it is your insurance limiting it or the pharmacy. There is a reason for this...take too much and it can cause some very serious side effects. However, there may be times when you need to vary your dosage (as prescribed by your doctor).

Lets say that you typically take 50mg Imitrex at the onset of a headache and you need to refill your prescription every month or even 2 months. This drug is expensive (somewhere around $80), especially if you look at it from the point of only getting 9 pills at a time. Imitrex also comes in a 100mg dose (a packet of 9 pills, each one = 100mg). If you must vary your dosage, ask your Dr if it would be appropriate to prescribe the 100mg tablets for you. There are many considerations they may take in making that decision.
1. Are you capable to take the responsibility to divide the pills?
2. Are you capable to know how to take it?
3. Are they willing to take that chance?

This is not an uncommon practice. Some may say that it's fraud or it's just not doing the "right thing". I am not advocating fraudulently prescribing of medication. Based on your individual situation, this may be a very sensible solution. Your doctor will know if this option is appropriate for you. If so, you may not need to fill your prescription as frequently thus spending less money for your required dosing.

Ask your doctor if it is appropriate for your situation. Always follow your doctor's recommendations and never reduce your dosage or half your pills unless directed to do so.