by M. Wuori, Rolla High School, Rolla, North Dakota
The High Cost of Unnecessary Testing in America's Healthcare System
In 1960, the United States spent $60 billion on health care, in 1980, $230 billion, and in 1990, $606 billion was spent on health care. Sound like a lot of money? Even more shocking is the prediction that our national medical bill will triple by the year 2000. The United States' health care costs are skyrocketing out of control and it's time our government took aggressive action to control costs. One way to control costs is to put an end to unnecessary testing as unnecessary testing is on of the greatest factors contributing to high medical costs.
Fifty years ago, a doctor puzzled by a patient's condition could do little except make an educated guess. Today that's no loner the case as doctors can now choose from over 1500 tests to assist in their diagnosis. Over 10 billion tests are performed annually in the United States, costing $100-150 billion and consuming one of every three dollars of the nation's $600 billion+ health care bill. Testing has very good outcomes. They ease pain, cure illness, and save lives and detected early, illness and disease can be treated successfully. However, it is sometimes thought that if testing is good, a lot of it is even better. This has allowed for the excessive use of testing in our health care system to go on without criticism. However, a growing number of studies indicate that 20-30% of tests performed in the United States are unnecessary and do nothing more than push up medical costs.
One of the main reasons doctors perform unnecessary tests is to protect themselves from accusations of negligence and malpractice suits. A recent American Medical Association survey showed showed that 75% of the doctors polled ordered more tests than necessary because they were afraid of being sued. These tests add as such as $67.5 billion a year and experts like former U.S. Surgeon General, C. Everett Koop, feel this cost is several times higher. The second reason for unnecessary testing is that an increasingly higher number of doctors have investments in the facilities they practice or refer patients to. At least one out of every eight doctors nationwide has money invested in these facilities, according to a study by the Inspector General of the U.S. Department of Health and Human Services. Physicians also own on out of our labs and treatment centers. This study found that the patients of these doctors receive 45% more tests than doctors who don't have financial ties to medical facilities.
The third reason many doctors and hospitals perform excessive tests is because they have the chance to do so under many insurance programs. Research has shown that doctors paid fee by fee by insurance companies, order 50 percent more electrocardiograms and 40 percent more x-rays than doctors receiving set salaries. A quote from Edmund Kelly, group president of Aetna Life and Casualty, best describes this situation: "The problem with our medical financing system is that most doctors get paid for doing thing to people, not for keeping them health."
Clearly dollars are being wasted that could be used more wisely but how can the government implement laws to reduce unnecessary testing? There are many possible ways to control excessive testing.
First by limiting malpractice awards for factors such as pain and suffering, doctors would not fear malpractice suits as much and therefore would not have to order as many tests. If the federal government followed California's example, malpractice premiums would be limited. California placed a limit on pain and suffering awards in 1975 and now has some of the lowest malpractice premiums in the country.
Secondly, more money and resources need to be put into finding out which tests and procedures are most effective and in what instances. Once this is studied, guidelines must be published and supplied to all doctors. If doctors know what works in treating and diagnosing various ailments, they won't have to perform just-in-case tests.
Thirdly, guidelines must also be supplied to patients, informing them of the risks and outcomes of certain medical testing. Patients must be encouraged to ask whether the result of tests will affect the doctor's choice of treatment. If it won't, patients must ask why it is being performed.
Fourthly, doctors should be required to inform patients of their investments in testing centers and laboratories and offer an alternative which the doctor is not involved in.
Finally, insurance companies should insist that doctors be paid flat fees or salaries for their services instead of paying fee by fee. An example is HMOs (Health-Maintenance Organizations) which charge group insurance plans an annual fee for treatment and cost 17 percent less than other facilities.
If we implement laws and cut out the unnecessary testing that overabundantly exists in our health care system, we could save billions each year. These billions could be used to provide adequate medical care for over 35 million medically uninsured Americans. Health care should not be a luxury only the wealthy can afford. We must take action now to improve our health care system to make medical care both affordable and available to all Americans.
