Distorted cost cutting efforts prove dubious
The following are some real illustrations of the effects of willy-nilly cost cutting:
• A study conducted by the Institute for Clinical Outcomes Research in Salt Lake City and financed by six HMOs provides evidence that patients using prescription drugs restricted to closed formularies were found to have the highest overall health care costs. The narrow list of drugs, meant to save money, excluded numerous treatment options better-suited in individual cases. Researchers reported that when less effective drugs are used, the result can be to worsen or prolong the condition and increase the total cost for the sake of saving money on the original prescription.
The study showed many patients taking cheaper drugs require twice as much medical care. As restrictions on drug choices increased, researchers found more patient visits to physicians, more emergency department visits, and more hospitalizations (American Journal of Managed Care, April 1996).
• A study reported in the November issue of Stroke showed death rates during the 90 days after a stroke were 36% lower for elderly patients treated by neurologists rather than family practitioners the caregiver favored by many health plans. Researchers say an explanation for the difference in survival rates may be that neurologists’ patients benefited from better diagnosis, treatment, prevention, and rehabilitation. But the study also found specialists cost 34% more.
• A physician recounted the following "ethical problem" at a conference in Wisconsin: A 10-year-old boy under treatment for acute myelogenous leukemia was not responding well, and the physician thought the boy was a good candidate for a bone-marrow transplant. But if he authorized one, he said, it would "eat up the capitation" for all the children in the health plan for several months. He didn’t divulge what happened, but said physicians should abandon the role of patient advocate and become "responsible stewards of society’s resources." (Nursing Management, September 1996.)
• People who remain in outpatient cardiac rehab programs for an average of 2.5 years have better health for up to five years longer than those on shorter program. But length of participation in outpatient cardiac rehab programs has gradually decreased in recent years and is currently limited to about 12 weeks (American Journal of Cardiology, October 1996).
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