YONKERS, N.Y., Oct. 1 /PRNewswire-USNewswire/ -- A new Consumer Reports
investigation, published in the November issue, identifies 10 "Overused
Tests and Treatments" and spells out how consumers can navigate a
health-care system that rewards costly -- and often unnecessary -- tests
and procedures and de- emphasizes 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.
Ten Overused Tests and Treatments
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
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
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
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.
Influx of New Drugs That Aren't Necessarily Breakthroughs
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
Shortchanging The Basics, De-Emphasizing Preventive Care
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.
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SOURCE Consumer Reports