June 22, 2020


People Have Stopped Going to the Doctor. Most Seem Just Fine. (Sandeep Jauhar, June 22, 2020, NY Times)

Most patients, on the other hand, at least those with stable chronic conditions, seem to have done OK. In a recent survey, only one in 10 respondents said their health or a family member's health had worsened as a result of delayed care. Eighty-six percent said their health had stayed about the same.

[A]  vast majority of patients seem to have fared better than what most doctors expected. It will probably take years to understand why. Perhaps patients mitigated the harm of delayed care by adopting healthful behaviors, such as smoking less and exercising more. Perhaps the huge increases in stress were balanced out by other things, such as spending more time with loved ones.

However, there is a more troubling explanation to consider: Perhaps Americans don't require the volume of care that their doctors are used to providing.

It is well recognized that a substantial amount of health care in America is wasteful, accounting for hundreds of billions of dollars of the total health care budget. Wasteful care is driven by many forces: "defensive" medicine by doctors trying to avoid lawsuits; a reluctance on the part of doctors and patients to accept diagnostic uncertainty (which leads to more tests); the exorbitant prices that American doctors and hospitals charge, at least compared to what is charged in other countries; a lack of consensus about which treatments are effective; and the pervasive belief that newer, more expensive technology is always better.

One of the most significant factors in wasteful health care is having too much supply of health care per capita in certain areas. In specialist-heavy Miami-Dade County, for example, Medicare spends more than twice per person what it spends in Santa Fe, N.M., largely because there is more per capita utilization of doctors' services. Sadly, more care doesn't always result in better outcomes.

If beneficial routine care dropped during the past few months of the pandemic lockdown, so perhaps did its malignant counterpart, unnecessary care. If so, this has implications for how we should reopen our health care system. Doctors and hospitals will want to ramp up care to make up for lost revenue. But this will not serve our patients' needs.

People need to have "coverage" to allay their financial concerns, but denied procedures (by those notorious death panels) that don't improve outcomes.

Posted by at June 22, 2020 7:40 PM