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Surgeons,as many doctors will tell you, tend to be overconfident in the efficacy of surgery. In the 1930s,lobotomies were commonly used on mental patients. Today,the costs racked up in unnecessary surgery may be in the hundreds of millions.
Fortunately,the movement to "Evidence-based medicine" promises to save billions in unnecessary and dubious medical treatments. Business Week last year did a cover story “ MEDICAL GUESSWORK. From heart surgery to prostate care,the medical industry knows little about which treatments really work.” No doubt there are implications in this article for Irish medical practices.
A large part of the article dealt with the career of Dr David Eddy,a heart surgeon,mathematician,operations researcher and health care economist, who has pioneered rigorous statistical approaches to evaluating medical treatments. His pioneering research has uncovered the inefficacy of many treatments.
His research and that of others into evidence-based medicine encouraged American health care insurers and health care providers to refuse payment for many inefficacious and dubious treatments. But there is still enormous waste in the American health care system,as illustrated by the following excerpts from the article:
[] “A great many doctors and health-care quality experts have come to endorse Eddy’s critique…most of these physicians say the proportion of medicine that has been proven effective is still outrageously low-in the range of 20 to 25%.”
[] “Evidence says surgery does not fix the problem [aching back] over the long term any better than time,physical therapy and exercise.”
Table of figures supplied for spinal surgery in the USA: 325,000 spinal fusion operations a year, $50,000 average cost of hospitalisation (for a total of $16 billion!)
[] “Except for 3% of people with severe heart disease,treatment with drugs alone works just as well to extend life and prevent heart attacks as surgery does.”
Table of figures for heart operations: 400,000 bypass surgeries, $20,000 average cost (for a total of $8 billion);1 million angioplasties,costs unquoted.
[] “VESTED INTERESTS…More troubling,many doctors hold not just a professional interest in which treatments to offer,but a financial one as well.”
[] “Yet middle-aged Americans are in far worse health than their British counterparts,who spend less than half as much and practice less intensive medicine,according to a new study.
From the foregoing,one implication for Irish medical practices is that proposals for surgery must be subject to close,sceptical scrutiny and possible veto by the HSE,VHI and Quinn Health. Surgeons simply can not be trusted to act against their own self interest. Another obvious implication is that the funding agencies refuse to pay for dubious or unproven medical procedures.
VHI and Quinn Health could use evidence-based medicine as a business model for low cost insurance,achieving savings on bloated payments for health care costs. The insurance could be priced cheaply to attract a mass market, providing very low cost medical insurance for the 55% or so of the Irish population which is not presently health insured.
Insurers would make clear that such low cost insurance would pay only for medical treatments that are likely to work,especially in the case of expensive medical procedures. No doubt,this would antagonise the medical establishment. Like many American medical insurers,Irish insurers would have to train a highly professional,medically qualified claims staff in evidence-based medical statistics who would be capable of advising policyholders on their medical treatment options, and capable of challenging the judgements of doctors in prior consultations about permissible medical procedures.
Of course,insurers could go too far in denying surgery and expensive treatments,so patients would need a legal right of appeal to an independent government appeals board.
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Originally Posted by patslatt