Thursday, June 18, 2009

Getting a physical

I got a physical exam a couple of weeks ago and went in for a follow up Tuesday to discuss my lab test results. Fortunately everything was normal.

A recent news report on rising health insurance costs suggested increasing worry about losing coverage was encouraging more utilization contributing to cost increases.

Costs will rise in part because workers worried about losing their jobs are using their health care more while they still have it ...

This initially seemed plausible to me as I have been thinking I should get stuff done while I am still covered under Cobra. But reading further in the story:

The 9% increase predicted for 2010, however, represents a slight decrease from the 9.2% PWC projected for this year, and 9.9% predicted for 2008 ...

which causes me to doubt that increasing insecurity actually explains much. The 9% annual cost increases are alarming and obviously cannot continue indefinitely.


  1. In my view, something in the current heatlh care system is increasingly worrisome and that is the fact mentioned at the end of the article: the providers' income is directly tied to simply doing more. While there are many individual doctors who keep their professional honesty, overall I would suspect the trend will be comparable to what is more common in the automotive industry - we'll give you a free inspection [but you will pay for all the not-necessarily necessary repairs resulting from it]. I am usually very hesitant to go to see a doctor with minor issues just to avoid the lengthy discussion whether the proposed medication(s) and procedures are really necessary. Even my dentist surprised me recently with an obscurely sounding procedure to clean under the gums which would from there on "lock me in" a repeating cleaning schedule and preclude me from normal cleanings (due to collateral damage this procedure does to the teeth/gum). I had to wiglle myself out of it as I do not believe I really need it.
    I agree with the comment that this phenomenon probably contributes to the annual increases most and needs to be fixed first. However, I prefer to see this fixed by changing the stimuli to the otherwise healthy system rather than replacing the system by a government-run monster.
    Glad to hear your "inspection" went well :)

  2. The dentist may not be trying to rip anyone off.Dental cleanings are important, but sometimes more is needed. The procedure he suggested may be scaling, which is a really deep cleaning under the gumline. I had it done once when I neglected cleanings for a while. Gum infections can set in when things aren't right. You could do more research on this procedure. Cleanings do help prevent heart infections and other health issues so it's important to do them regularly.

  3. I did not claim they would try to rip off. I merely stated my belief that, given the current system where their income is tied to the volume of procedures, the doctor will lower the threshold for deciding whether a procedure should be applied or not. One can always (I mean always, even if it becomes absurdly petty) argue that a procedure will mitigate certain risks. However, those particular risks can be very small, and the side effects may increase other risks. The balance is typically debatable, hard to identify, and often undecidable. Just look at how lightly antibiotics are prescribed. "Better feed'em with it than have an infection in that one in 10 million case" ... and a resulting 10 mil lawsuit.

  4. I have heard that the U.S has something like twice as many surgeons as Great Britain, and that around twice as many surgeries are performed in the U.S. as in Gerat Britain. This would indicate that more tests, procedures and surgeries must be performed here and that some of those tests and procedures could have serious complications. It makes one wonder if an expert who profits from recommending a procedure should be doing the procedure him or her self. Is this a conflict of interest?

  5. Good question! By common sense, no matter how much we trust doctors we all feel this conflict is there to some degree.
    Whether it can be reduced by something like you are suggesting - I don't know. I imagine the industry has probably tried a lot of ways to counteract this phenomenon and what we see today indicates there has not been much success.

  6. The problem is a great deal bigger than whether a medical professional may profit by theie advice to us. We can apply the same reasoning to life insurance salesmen, investment advisors, real estate salemen, accountants, lawyers, etc. The question is whether there is really anyone out there that we can trust to give us a straight answer.

  7. In all of the above examples there is an a-priori understanding that these professions do make money on what they convince us to buy from them, so we can adjust accordingly. However, with doctors, our expectation is that the number one concern is your health and health only. In clear-cut cases, there undoubtedly doctors have to do what they have to do, however, in many instances your health is not directly endangered and they (more and more) tend to maximize their revenue. Maybe the solution to the problem is to learn to accept this, but it won't solve the problem of ever increasing healthcare costs.

  8. I would like to propose that we not get used to the status quo if it is not the way things should be. The question is what can do done about it.