![]() The United States significantly outspends all other industrialized nations in health care, yet does worse in most measures of quality. MRI’s for uncomplicated headaches are on the rise, despite guidelines recommending they not be used. Pre-operative chest X -rays are often ordered for patients with no symptoms of heart or lung disease, even though they are unlikely to yield useful information. Arthroscopic knee surgery for osteoarthritis works no better than a placebo surgery, and yet it continues to be routinely performed. Health care spending in the United States is bloated by payments for expensive treatments that are unnecessary and ineffective. Policymakers should instead focus on ways to reduce unnecessary care. These approaches, however, would severely harm vulnerable segments of the population. Discussions have largely centered on options like reducing coverage or removing sick people from risk pools. In the current health reform debate, policymakers are looking for ways to lower both premiums and overall health insurance costs. Addressing Challenges and Suggestions for FurtherĦ. The Autonomy Value is Important but Dangerous if UnalloyedĪ. Between Autonomy and Death Panels: The Need for a NudgeĪ. Legal Constraints and Desire to Avoid Negative Publicity Difficulty and Administrative Cost in IdentifyingĢ. Why Payors Often Reimburse for Unnecessary Careġ. The Pendulum Swings (Mostly) Back to Physician-Driven Reimbursement (1990s–Present)ī. A Move to Insurer-Driven Reimbursement Decisions (1970s–1990s)ģ. Deference to Physicians (Early Years–1970s)Ģ. History of Insurer Approaches to Coverage Decisionsġ. Rational Insurers Should Screen for Unnecessary Care, But Laws, Markets, and Norms Get inĪ. The Actors That Contribute to High Rates of Unnecessary Care High Rates of Unnecessary Care Increases Premiums and Harms PatientsĬ. Rising Premium Rates in Health Care and the Unnecessary Care Causeī. The Problem: High Rates of Unnecessary and Ineffective Health CareĪ. Because insurers lack appropriate incentives to nudge, the law must mandate them. Such computer-driven nudges have been effective in other contexts and would reduce premiums without harm ing those most in need of help. Insurers should require, by contract, that providers receive an automated warning before ordering commonly overused interventions. A toxic combination of mismatched legal incentives, market failures, and industry norms means that the insurance market cannot solve the problem absent intervention.īut this intervention could be a simple nudge: steering decisionmaker s away from unnecessary care, while protecting the autonomy of doctors and patients. This Article unravels the mystery of why the insurance market has failed to excise this waste on its own. Instead, reform should target the $ 210 billion worth of unnecessary care prescribed by doctors, consented to by patients, and paid for by insurers. Removing sick people from risk pools or reducing health plan benefits-the focus of lawmakers’ attention-would harm vulnerable populations. ![]() Lawmakers are looking for Affordable Care Act savings in the wrong place.
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