Consumer Reports identifies 10 overused medical tests and treatments

Posted Friday, November 16, 2007

 E-mail this page    Printer-friendly page

How U.S. Health Care Bill Got To Record-Breaking $2 Trillion: Too Much Treatment, Too Many Drugs, And Too Little Preventive Care

 

The CR investigation identifies three main problems in the U.S. health-care system: unnecessary tests and treatments; costly new drugs that are often no better than the older, cheaper ones; and a glaring under-appreciation for preventive care. The investigation is the second in a series about health care. The theme of dysfunctional profit incentives was brought to light in the first installment, published in September, in which CR took note of the deteriorating ability of insurance companies to slow the growth of medical costs since 2000. The annual U.S. health-care bill, reports CR, has risen to $2 trillion, its highest point in history.
For consumers unfamiliar with the term “fee for service,” CR explains: Because the vast majority of doctors and hospitals are paid on a piecework basis, the more services they provide, such as blood tests, surgeries, MRIs, and CT scans, the more money they make. Experts estimate that the nation's $2 trillion annual health-care tab is one-third to one-half higher than need be, in part because of overuse of expensive treatments and unnecessary care. CR's overused tests and treatments are listed below:

1. BACK SURGERY: Don't rush to surgery for a simple slipped disc. In 90 percent of cases, the pain goes away on its own within six weeks. In stubborn cases, surgery, which can cost $20,000 plus physician fees, can relieve pain somewhat faster than physical therapy and medication, a recent study showed. But the study notes that both groups of patients wound up with similar improvements after two years.
2. HEARTBURN SURGERY: A surgical tightening of the sphincter muscle that blocks stomach acid from backing up into the esophagus typically costs $14,600 or more, and provides no better long-term relief than taking a proton-pump-inhibitor drug, which costs less than $1 a day.
3. PROSTATE TREATMENTS: Prostate cancer surgery can cost $17,000 or more and is often done without adequate discussion of the alternatives or the high risk of incontinence or impotence.
4. IMPLANTED DEFIBRILLATORS: One-third of people who get these devices might not really need them, research shows. This year Medicare will pay for an estimated 50,000 of the devices, which automatically shock the heart back to a normal rhythm (each costs some $90,000 over a lifetime).
5. CORONARY STENTS: Billions are spent each year inserting tiny mesh tubes to prop open coronary arteries. But the procedure plus heart drugs turns out not to work any better to prevent future heart attacks than heart drugs alone for patients with stable coronary artery disease, research shows.
6. CESAREAN SECTIONS: At a cost of $7,000—approximately 55% more than natural delivery—most cesarean sections are performed because labor is progressing too slowly. Cesarean sections were used for a record high of 30.2% of births in 2005. But several less-invasive approaches might be enough to speed up labor.
7. WHOLE-BODY SCREENS: These CT scans, at a cost of $1,000 or more, have no proven benefits for healthy people, according to the Food and Drug Administration. Plus, CT scans expose patients to far more radiation than X-rays.
8. HIGH-TECH ANGIOGRAPHY: Using a CT scan to noninvasively check coronary arteries for narrowing costs an average of $450, according to data from HealthMarkets, which sells health and life insurance through subsidiaries in 44 states. But standard angiography is sometimes still needed to confirm blockages that might require aggressive treatment.
9. HIGH-TECH MAMMOGRAPHY: Using software to flag suspicious breast X-rays would add $550 million a year to national costs if used for all mammograms. A 2007 study found it failed to improve cancer detection rates significantly while resulting in more needless biopsies.
10. VIRTUAL COLONOSCOPY: A study in 2007 concluded that standard colonoscopy is better at spotting smaller suspicious polyps. While less costly than the standard procedure, virtual colonoscopy isn't cost-effective because any suspicious finding requires retesting with the real thing.

CR's Recommendation: Consumers should designate one doctor, typically a primary-care physician, to coordinate care. Patients should ask which treatments have been shown by research to be best for their given condition. And when tests are performed, inquire what the consequences are if the results are positive.
 
The pharmaceutical industry spends an estimated $29.9 billion a year promoting newer brand name prescription drugs. But CR notes that despite the billions spent on promotional activities such as direct-to-consumer ads, free samples, and showering physicians with gifts and cash, newer drugs aren't always better. In fact, for a manufacturer to secure FDA approval of a new drug, it need only prove that the drug works better than a sugar pill, not that it's better than other remedies. So most of the “new” drugs that the FDA approves—75 percent in 2005—are me-too versions of existing remedies rather than genuine breakthroughs.

CR's Recommendation: Consumers should ask their doctors for generic drugs whenever possible. When offered a newer drug, its best to ask if it has been proven better or safer than its predecessors. A free Consumers Union Web site, Best Buy Drugs, provides comparative treatments and cost information on most major categories of drugs, based on analysis of published studies of the drugs' effectiveness and safety. Log on to http://www.ConsumerReports.org/health.
 

As a consequence of a payment system that discourages prevention and management of care, Americans spent almost $29 billion on 4.4 million hospital stays for potentially preventable conditions in 2004, according to a recent study. Health-care costs are ballooning partly because the system is geared toward expensive interventions and remedies after health problems develop. The U.S. doesn't have a system in place, notes one doctor, for rewarding the education of patients as to why it's important to change behavior to improve their health. And many new physicians are avoiding the primary care field altogether; new medical student graduates, often saddled with six-figure student loans, are increasingly opting to forsake primary care for the bigger paycheck of a specialist.

CR's Recommendation: Consumers should take lifestyle changes seriously, especially if they're at risk for heart disease, stroke, diabetes, or cancer. People with a chronic disease should work with their doctor to devise an effective plan to manage it.

Consumer Reports has no commercial relationship with any advertiser or sponsor appearing on this newspaper's web site.