Monday, April 21, 2014
Who Shall Decide?
The press has recently included a number of articles about a
movement under way to have doctors take cost into account when making clinical
decisions. The idea is that whereas the
ethos of medicine has been that the doctor should only consider what was
clinically best for the patient, cost has reached such a level that perhaps it
should be considered as well.
There is some disagreement about that, of course, and in the
New York Times article of April 18 on the subject, Dr. Martin Samuels, chief of
neurology at Brigham and Women’s was quoted as saying “There should be forces
in society who should be concerned about the budget, about how many M.R.I.s we
do, but they shouldn’t be functioning simultaneously as doctors.”
I see merit in that point of view, but it leaves open the
question of who those “forces” should be.
The “who” most active in this area at present are insurance
companies, not my first choice as I think they will always be suspected of
being motivated more by financial considerations than by the interests of
patients.
I’m not thrilled about government doing it, either. I wouldn’t feel comfortable having decisions
about how much my health care can cost in the hands of politicians mainly
concerned about surviving the next election.
My vote would be for my local, non-profit community
hospital, controlled by trustees who are my friends and neighbors, united with
its doctors, and operating in a market designed to reward providers who provide
the best value for money spent – best value being defined as my best
interests.
