“It isn’t enough to eliminate unnecessary care. It has to be replaced with necessary care. And that is the hidden harm: unnecessary care often crowds out necessary care, particularly when the necessary care is less remunerative… …The system gives ample reward for over treatment and no reward for eliminating it…. …Doctors there described a profit-maximizing medical culture. Specialists not only made money from the services they provided; many also owned stakes in home-health-care agencies, surgery and imaging centers, and the local for-profit hospital, which brought them even bigger returns from health-care overuse… This was the way he wanted to practice—being rewarded for doing right rather than for the disheartening business of churning through more and more people… …what the oldest and sickest most needed in our hyper-specialized medical system was slower, more dedicated primary care… …Could a backlash arrive and halt the trend? It’s a concern. No one has yet invented a payment system that cannot be gamed. If doctors are rewarded for practicing more conservative medicine, some could end up stinting on care… …not all quality can be measured. It’s possible that we will calibrate things wrongly, and skate past the point where conservative care becomes inadequate care. Then outrage over the billions of dollars in unnecessary stents and surgeries and scans will become outrage over necessary stents and surgeries and scans that were not performed”
In the New Yorker Dr Atal Gawande asks what we can do about the avalanche of unnecessary medical care that is harming patients physically and financially.
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