September 2008

A perspective on health care costs today

by Dr. Richard Barwell

The other day, I was reading an article in AARP -- The Magazine (the publication of the American Association of Retired Persons) and found some enlightening information. Now here I have to say, no, I'm not retired but, yes, I'm old enough to get the magazine. If you live outside the United States, bear with me, as the results will be relevant.

The article was titled, "Why does Health Care Cost So Much?" and was written by Shannon Brownlee, author of "Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer" (Bloomsbury, 2007).

She stated: "Even as millions aren't getting treatments they vitally need, a leading medical journalist argues that the main culprit in the soaring costs of American health care is actually over treatment… and all the extra care is making us sick".

This is a very bold statement to make about a profession that doesn't take criticism well.

She went on to talk about the ranking of the USA with regard to life expectancy (lower than Canada, Japan, and all but one of the Western European countries) and that the US ranks 43rd in infant mortality.

The three reasons she cites for high health care costs in this country are: 1) too easy access to care, 2) malpractice costs, and 3) administrative costs. Yet, even when these are added together they don't account for the majority of the costs. Wait until you find out the real reason.

One factor is that the chronically ill, who make up about 20% of the patients, account for 80% of the spending. These patients have multiple health challenges such as diabetes, heart problems, and high blood pressure. No shocking information here but the real reason for the high costs is just plain and simple "too much unnecessary care."

Noted Dartmouth researcher Elliott Fisher, MD, says that unnecessary care leads to the death of as many as 30,000 Medicare (over 65) recipients annually. Studies show that 50% of surgeries, tests, and procedures are not backed by scientific evidence. Tonsillectomies are performed that are not needed. Procedures, tests, hospital stays and surgeries all done because of aggressive care based on old patterns and inconsistency.

Two towns located two hours apart showed a difference in tonsillectomies for children under the age of 16 to be under 10% for one town and nearly 70% for the other. Comparing heart attack care in Los Angeles and Salt Lake City, LA's Medicare cost was $30,000 while that of SLC was $23,500. Moreover, LA showed a higher rate of death. I guess the death cost $6,500!

And, how about spinal fusion to treat acute low back pain? $16 BILLION a year on this surgery, even though there has never been a rigorous government-funded clinical trail showing that the surgery is superior to other methods of relieving low back pain.

The author gave her conclusions as to why these costs are so high.

Patients are too demanding. They insist on a drug or treatment they have seen or heard advertised in the media. MDs fear they will lose a patient if they refuse the demanded care (patients demanding care for the children are the worst). Doctors fear lawsuits if they don't order tests even when they know the tests won't help or may even cause harm. Also, MDs make more income by ordering more tests and procedures.

Robert P. Lindeman, MD, a Natick, Massachusetts pediatrician said, "We practice defensive medicine so often, every day, all the time, we aren't even aware we are doing it."

Ms. Brownlee wrote: "All too often -- but what's not well known by the public -- is that many physicians don't even know what better care is. The prestigious Institute of Medicine recently published a report that estimates that only about half of what doctors do today is backed up by valid, scientific evidence. The rest? Many procedures and tests are based on medical tradition or on unproven and potentially faulty assumptions about how the body works."

After reading the article, I was fighting mad and had to stop and think about this in respect to the chiropractic profession. Are we any better? While we like to think we are, how many of our procedures have been verified? Who did the research? Is it the promoter of the technique? Was the care judged through objective or subjective findings? Is the exam you do really of value or is it based on outdated orthopedic tests? Do you have an objective method of measuring the need for care? Do you participate in research that will further the profession? And finally, are you basing your care on tradition or on unproven and potentially faulty assumptions about how our body works?

Neurologically-based chiropractic and the new instrumentation can move the profession past these challenges. It's time to move to the 21st century!

(Dr. Richard Barwell is the founder and president of the chiropractic Equity Offices, Inc. program, and has more than 30 years of experience in chiropractic practice. After graduating with honors from Canadian Memorial Chiropractic College in 1964, he started a family Wellness Practice in British Columbia. He has since established numerous successful practices, won several awards and guest lectured at various chiropractic institutions. Before establishing CEO, Inc. Dr. Barwell was the director of seminars and programs at Quest and executive director of the chiropractic Leadership Alliance.)