by Dr. Ong Hean Teik in the Malay Mail
There is no doubt that patients are spending more on healthcare, yet doctors claim to earn less and hospitals deny making large profits. There have been three major developments in medical practice over the last few decades that may explain this phenomenon and understanding them can suggest possible solutions. We all need to cooperate to make costs lower yet maintain healthcare standards.
Medical practice today involves much more technology use and the performance of tests. While they improve accuracy, modern medical tests are very expensive. Doctors incur additional time and expenses getting the necessary training to perform these studies, while hospitals often spend millions in getting and updating the new machinery. Therefore patients put through these tests end up with a much higher medical bill. In America, doctors and hospitals have been charged and fined for performing unnecessary tests and treatment, while a pharmaceutical company paid over US$2 billion to settle charges of unethical drug promotion. Yet patients sometimes specially seek new tests and treatment that they have read about, leading to the diagnosis of a condition that may not have any effect on their health nor cause any discomfort. For example, it is not recommended for cancer markers and PSA to be done on healthy individuals as part of routine health screening as they lead to more tests and overtreatment that have been shown to be bring no overall benefit to the patient. Patients should not worry about consultation fees; to reduce healthcare expenses they must avoid unnecessary tests and procedures. Before agreeing to any test or treatment, patients must be clear how it will benefit them, either in reducing discomfort, future ill health or in extending longevity. Ask for a medical report, seek a second opinion or do some research from the Internet. The Ministry of Health and responsible medical organisations can play a role in patient education, rather than become advertisers for the latest technology. After all it is too much to ask that those profiting from tests explain their limitations.
The second major change over the years has been the evolution of the doctor-patient relationship. Previously the sick seek a doctor, located in any shop lot, who then offers treatment compounded or packed at the clinic premises. Today clinics have to meet strict guidelines of the Ministry of Health, requiring substantial time and expenses. Medicines come in individual strip packs, complete with holograms to prevent counterfeit. A hospital now has pharmacists, physiotherapists and dieticians, with specialised accounts staff to handle insurance claims. While the introduction of new regulations and expansion of para-medical services can bring about better patient care, it results in substantially increased costs. Managed care organisations and insurance personnel who derive financial benefit must be paid out of the health budget and thus cannot reduce healthcare costs. Patients sometimes seek out, or are referred to, many specialist doctors who each perform tests and treat a part of the human body. This results in very much higher medical expenses, and often the patient ends up confused and even in poorer health. When specialists are rewarded for doing more, will not the result then be excessive tests and treatment? Unlike older medicine which are not potent but may cause no harm, modern medical tests and treatment are not free of unwanted side-effects. Excessive radiation from X-rays can increase cancers, stenting a coronary artery in the stable patient does not reduce future heart attacks, cholesterol medicine can increase diabetes and some diabetes medicine can increase heart failure! Paying more consultation fee to a general practitioner who then spends more time to analyse a patient’s complaint may thus paradoxically lead to lower healthcare expenses. This is actually one of the objectives of the Obamacare legislation in America, a country with the highest healthcare expenditure in the world but whose health data trail far behind others. When it comes to doctors and treatment, more need not bring better health but it will certainly be more expensive.
Finally the third cause of escalating healthcare costs is the misunderstanding patients and relatives have of the capability of modern medicine. When doctors, and the media, speak of curing cancer or heart disease, it is that the condition is controlled no longer causing distress and perhaps the patient’s life may be prolonged. But the disease does not disappear. Cardiac by-pass surgery does not cure heart disease in that the condition can recur, and patients will always need to be on medication. Fitting the unconscious stroke patient to a respirator will prolong life but not aid recovery. While relatives often ask doctors to ‘do everything possible’, when doctors or their own relatives fall ill, they often seek not to prolong existence but to reduce suffering and ensuring comfort. Doctors have come to accept that disease and mortality ultimately affects all human life but many patients and their relatives seem not to realise this. Data shows that most medical expenses are spent right at the end of life, with little benefit to patient or family. To care for the ill is not the same as spending money to prolong suffering.
The increasing suspicion and acrimonious debate on medical professional fees is not good for patients, doctors, hospitals or even the community. The Ministry of Health should set up competent, exemplary and patient-orientated service at its public hospitals and clinics to give patients an inexpensive option. Presently many clinicians in the ministry spend too much time and energy attending meetings and on bureaucratic work. Clinic and ward conditions are not conducive for patient comfort, making it less obvious that the facilities are in fact very good. Having good clinical public institutions will then force private healthcare to regulate and lower charges as they seek to compete.
Ill health can affect us all regardless of profession, status or political inclination and it is an area we must work together for our common good. Expensive and wasteful healthcare spending benefits no one, not even those who profiteer temporarily from it.
* Dr Ong Hean Teik is a consultant cardiologist at the HT Ong Heart Clinic in Penang.