Re: Doctors should be taught to consider the cost of their practice
I agree with Bela Nand that doctors should be trained to think of the consequences of ordering expensive investigations (1) the impact patient care and what will be done with a positive result.
GMC guidance on shared decision making suggests that investigations should involve a discussion with the patient regarding what we are looking for with the test and the risks/benefits of undergoing it (2). It should also be considered that a positive test often leads to ordering another or intervention with further costs.
In the NHS environment doctors are primarily driven by service to the patient rather than service to an insurance company as in the US system where financial incentives are sometimes offered to clinicians by insurance companies to drive down costs. This has been shown to alter physician behaviour although the impact on patient outcome is unclear (3).
Increasing costs of healthcare are a result of the success of the NHS rather than its failure. Saving lives leads to longer life expectancy and an aging population, each new medical and technological development raises the acceptable standard of healthcare, leading to ever escalating costs.
It is high time that the British public accept that healthcare costs are going to continue to escalate regardless of how much funding is put into healthcare and this will involve a trade-off with funding to other services, unlimited access to one service will lead to limits elsewhere.
There has been much drive to improve efficiency and limit wastage of resources (4). This is not a realistic option and a risky strategy in an environment which deals with unpredictable systems; one cannot deny treatment when the outcome is uncertain on the basis that it might not work or cut resources on the basis of a short term reduction in demand. Staff working in the NHS will appreciate how unpredictable and variable the workload and caseload can be even on a day to day basis.
In the face of uncertainty about the future of the NHS and healthcare funding in the UK it would seem prudent to limit the use of expensive investigations. I would also argue that limits need to be placed on the development of technological advances which add limited value to an already acceptable standard of care, the business sector creates new markets for products which are seldom cost effective in terms of public spending.
The public need to accept that access to healthcare and disease care is not unlimited and is not cost-free. Politicians need to face the hard truths rather than applying risky strategies to apply the metaphorical sticking plaster to a gangrenous wound.
A culture of openness with regards to what can be achieved and the setting of reasonable limits on a sound ethical basis needs to be embraced if the NHS is to move forward and continue to provide a high standard of care.
Rapid Response:
Re: Doctors should be taught to consider the cost of their practice
I agree with Bela Nand that doctors should be trained to think of the consequences of ordering expensive investigations (1) the impact patient care and what will be done with a positive result.
GMC guidance on shared decision making suggests that investigations should involve a discussion with the patient regarding what we are looking for with the test and the risks/benefits of undergoing it (2). It should also be considered that a positive test often leads to ordering another or intervention with further costs.
In the NHS environment doctors are primarily driven by service to the patient rather than service to an insurance company as in the US system where financial incentives are sometimes offered to clinicians by insurance companies to drive down costs. This has been shown to alter physician behaviour although the impact on patient outcome is unclear (3).
Increasing costs of healthcare are a result of the success of the NHS rather than its failure. Saving lives leads to longer life expectancy and an aging population, each new medical and technological development raises the acceptable standard of healthcare, leading to ever escalating costs.
It is high time that the British public accept that healthcare costs are going to continue to escalate regardless of how much funding is put into healthcare and this will involve a trade-off with funding to other services, unlimited access to one service will lead to limits elsewhere.
There has been much drive to improve efficiency and limit wastage of resources (4). This is not a realistic option and a risky strategy in an environment which deals with unpredictable systems; one cannot deny treatment when the outcome is uncertain on the basis that it might not work or cut resources on the basis of a short term reduction in demand. Staff working in the NHS will appreciate how unpredictable and variable the workload and caseload can be even on a day to day basis.
In the face of uncertainty about the future of the NHS and healthcare funding in the UK it would seem prudent to limit the use of expensive investigations. I would also argue that limits need to be placed on the development of technological advances which add limited value to an already acceptable standard of care, the business sector creates new markets for products which are seldom cost effective in terms of public spending.
The public need to accept that access to healthcare and disease care is not unlimited and is not cost-free. Politicians need to face the hard truths rather than applying risky strategies to apply the metaphorical sticking plaster to a gangrenous wound.
A culture of openness with regards to what can be achieved and the setting of reasonable limits on a sound ethical basis needs to be embraced if the NHS is to move forward and continue to provide a high standard of care.
References:
1. Nand, B. (2014) Doctors should be taught to consider the cost of their practice. BMJ 2014;348:g2629
2. http://www.gmc-uk.org/guidance/ethical_guidance/consent_guidance_index.asp
3.Rice, T. (1997) Physician payment policies; impacts and implications. Annual review of public health 18:549-65
4. http://www.institute.nhs.uk/establishing_evidence/establishing_evidence/...
Competing interests: No competing interests