Living in a Technology Culture
by Candice Chen (email author); Wednesday, October 7th, 2009I have a friend who buys a new cell phone every few months so that he always has the newest technology. At home, I have a high definition LCD television with a DVD player and a Wii console attached. What got me thinking about this? A statement I overheard today regarding health care –
The U.S. doesn’t focus on health care equity because we are so focused on promoting our state of the art technology.
In fact, this appears to be true despite health care. Our culture is focused on the newest and the most advanced technologies, whether that technology is related to our health or to our cell phones. And in general we have the expendable income to change cell phones every few months and buy the newest, flattest television. A new study from Canada suggests we treat health care similarly. The study found that higher educational attainment is associated with more specialty visits and bypassing of primary care.
But the question is – is this the right way to approach health care? Studies suggest the answer is no. Large scale analyses of Medicare beneficiary data, done by the Dartmouth Atlas and repeated by the GAO, show utilization of physician services varies widely by location and the GAO found –
Potentially overserved and other areas are similar in demographic characteristics and the capacity to provide health care services. The two groups are also similar in Medicare beneficiary satisfaction with health care. In contrast, certain types of physician services, such as advanced imaging and minor procedures, are performed more frequently in potentially overserved areas relative to other areas.
The Dartmouth group explicitly connects high service (and therefore high cost) areas to the greater use of specialists and inpatient services. Yet both seem to agree that outcomes are similar. Another study looking at treatment of back pain finds that outcomes are similar whether you go to a primary care practitioner or orthopedic surgeon. However, costs are significantly different – on average a primary care provider costs 30% less than an orthopedic surgeon, and this cost doesn’t take into account the cost to the patient in terms of unnecessary imaging and office visits.
The GAO suggests that “potentially overserved areas” use more services due to differences in physician practice patterns. And there likely are differences in practice patterns between regions, but patient preferences and practices, such as bypassing primary care providers, affect physician practices. We have a technology focused culture which translates into a specialty focused culture when accessing health care. But this culture doesn’t translate into a high quality and efficient health care system.
Primary care is struggling for many reasons - payment disparity, demanding lifestyle, lack of practice support, an education system which favors hospital-based specialty care - but the technology culture can’t be ignored. Patients make decisions before they ever reach a doctor.
So YES - we need to change physician practices and we need to make primary care more desirable, and we also need to change our American specialty focused culture.
We can continue to buy the newest cell phones and the clearest televisions, but when it comes to health care, we’re no longer getting a good deal. It’s time, as consumers, to choose a system that gives us the best outcomes and not just the system that is the newest and the shiniest.