Thursday, April 5, 2012

The Big Shift

Less care means lower health care costs. Possibly. Or it may just mean your insurance plan won't cover some things. If you want a test or procedure, you must pay.

Maybe that's a good thing.

Maybe not.

According to Yahoo News, as much as 30 percent of health-care spending goes to procedures, tests, and hospital stays that do not improve a patient's health.

If true, that is an astounding figure.

This is not a government study, but results from data collected and compiles by the American Society of Clinical Oncology.

Although the task force emphasized that its recommendations -- winnowed from about 10 suggestions by oncologists -- were driven by medical considerations, the report makes clear that expense was a major factor. A number of cancer drugs cost nearly $100,000 but extend life a few months or not at all. Widely-used imaging tests cost up to $5,000 yet do not benefit patients.

Many cancer drugs are expensive, some as much as $8,000 per dose. Most of the time the cost of the medication is covered by Medicare or private insurance.

If these recommendations are incorporated into future health insurance plans (including Medicare and Medicaid) the only way to receive these procedures is for the patient or their family to pay out of pocket.

At one large health maintenance organization, for instance, 49 percent of patients with a common form of lung cancer but with poor "performance status" (they were largely confined to a bed or chair and capable of only limited self-care) received chemo. Research shows, however, that it is unlikely to extend their life or improve its quality.

Similarly, many patients receive three and even four kinds of chemo after not responding to earlier rounds. Yet in the largest study of its kind, only 2 percent of lung-cancer patients responded to a third form of chemo; 0 percent responded to a fourth form. In another study, withholding fourth-line chemotherapy from patients with non-small-cell lung cancer or colorectal cancer did not shorten their lives compared to that of similar patients receiving last-ditch treatments.

This is a tough call.

When looking at stats, it seems like a no-brainer. But when the one in need of a test or treatment is you or a family member the perspective changes.

In breast-cancer patients who have been successfully treated, such as Shari Baker, neither the advanced imaging nor blood tests for molecules associated with tumors improve survival. (The tests do help patients treated for colorectal cancer, however.) Most recurrences are found through a physical exam or mammogram. Yet the advanced tests are routine.

"Why do doctors keep doing them?" Schnipper asks. "Most of them are aware of the evidence that these tests don't benefit patients. But in my own experience treating breast-cancer patients, sometimes when I go through the explanations of how these things don't help a patient will say, 'but it will help me sleep at night.' And I do it."

Tough call.

If your insurance refuses to cover a test or treatment, what will you do?

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