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.