Apr 11, 2019
It’s no secret that the USA has the most expensive healthcare in the world, but a new commentary by clinicians at Cornell and the University of Texas-San Antonio suggests our specialty-driven clinical practice guidelines may be at fault. This perspective comes from a panel of doctors who have practiced in other wealthy countries before coming to the US to live.
When they moved to the US, they were surprised to find that the recommendations for bowel cancer screening here differed so radically from those in their native countries. Then, they looked at the panels making the recommendations.
In the US, the American College of Gastroenterology panel, composed entirely of, guess who, gastroenterologists, universally recommends colonoscopies. In Europe, the European Society of Medical Oncology panel with six medical oncologists, one gastrointestinal surgeon, and no gastroenterologists states that colonoscopy has a limited role and recommends stool biochemical screening instead.
The authors further comment that one reason for the difference is our US fee-for-service model, and our docs get in the habit of recommending services they perform. When you are a hammer, everything looks like a nail since there is a financial incentive to view it that way.
So how is this costly care working out for us. Not well! On the list of healthiest countries, the US ranked #35 trailing all of the European nations. On the list of least healthy countries, we are tied with Lithuania at #10. The number one least healthy country is the Czech Republic followed by Russia.
For you as a patient, the bottom line is to be a good consumer of healthcare. Question your doctors about responsible alternatives to costly screening techniques and do check the internet to read reliable and balanced sources of information.
Ismail Jatoi, Sunita Sah. Clinical practice guidelines and the overuse of health care services: need for reform. Canadian Medical Association Journal, 2019; 191 (11): E297 DOI: 10.1503/cmaj.181496
Worlds healthiest countries: https://www.mdlinx.com/internal-medicine/article/3613
#Colonoscopy #health #healthcosts #feeforservice #universalhealthcare