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. 


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