In order to get health care spending under control, the US needs to reallocate resources from low-value to higher-value interventions. We spend billions of dollars on high-tech medicine that has limited and sometimes no evidence of clinical benefits to patients, yet carries a high price tag.
Examples include vertebroplasty, a procedure that injects bone cement into fractured vertebra in the spine to reduce pain. Two blinded, randomized controlled studies indicated that this procedure produces no greater reduction in pain among osteoarthritis patients with vertebra fractures than a placebo. Further, there are serious risks associated with this procedure, such as the cement leaking out of the immediate area into the body.
Vertebroplasty is expensive. This procedure costs at least $3,000 in an outpatient setting and upwards of $16,000 in a hospital setting. An estimated 70,000 to 100,000 of these procedures are done annually in the US. Medicare continues to pay for this procedure despite no evidence of benefit and considerable evidence of harms and a high price tag.
In sharp contrast, there are many high-value interventions with a clear evidence base. The benefits to health from these interventions have been clearly established, and the price tags are typically quite modest. Examples include:
- Childhood immunizations, where each dollar spent saves $18.40, according to the Partnership to Fight Chronic Disease.
- Smoking cessation assistance
- Screening for hypertension, high cholesterol, and colon cancer
- Daily aspirin use by people at risk for cardiovascular disease
- Regular exercise to avert obesity among children and adolescents
We certainly need to reform the US health care system by moving away from the fee-for-service system and reducing the fragmentation in the health care delivery system. But we need to devote much more attention to the factors that drive people into the health care system in the first place.