Related Sections: Medical Tech In-Depth
SHIFT: How medical technology can help cure U.S. health care
Health-care spending has doubled since the mid '80s. Trying to figure out why, lots of people are pointing fingers toward high-tech gadgetry, and the expensive drugs that advanced medical technology has created. That's understandable when a day in intensive care can cost $10,000. Spending on medical tech has risen to well over $200 billion per year and is responsible for 20% of those rising costs.
But wait a second. Sure, technology is inflating costs, but it's also saving lives, isn't it? The problem with medical tech isn't the cost, but that it's used at the wrong times and on the wrong patients. For example, how do you decide if a $100,000 drug should be administered to a terminally ill patient? That's where tech can help us out of this jam, using networked information to figure out where to aim these big guns.
Tech Successes
The medical tech landscape is heavily populated by success stories. Spiffy gadgets such as the MRI machine and PET scan can diagnose diseases that used to require invasive surgery. Cardiac defibrillators, now implanted in half of heart attack survivors, reduce the risk of death from a heart attack by 30%. The 3D HDTV da Vinci robot, even though it costs $1.5 million, allows near-microscopic accuracy in cardiac bypass and prostate surgery that was never possible before.
The technology is remarkable, and can save lives. The problem is, doctors use this technology on anyone who even remotely might be able to benefit from it. Sure, an implanted cardiac defibrillator might save a heart attack patient, but putting it in a terminally ill 95-year-old man is a waste of effort and $100,000.
Titanium knee replacements help people who would've had to remain disabled in the past. But is that a good idea to replace the knee of someone who is bedridden with terminal cancer? And that $1.5 million da Vinci robot can do amazing things, but many surgeries can be performed just as well without it, and, incidentally, without spending the $2,000 for parts that must be replaced after each operation.
Is It Worth It?
The problem is, there's no way for doctors to accurately assess just how successful particular treatments will be. And there's no reason to, because driving the decisions to use expensive tech is profit, not efficacy. Doctors (and especially their bosses who own the hospital) are eager to use each million-dollar machine they can get their hands on. Let's face it — when you get a new hammer, everything starts looking like a nail.
Doctors and hospitals need a way to accurately assess how effective treatments are, rather than how profitable. Our health care system needs widespread information technology to determine which treatments are most effective, or even necessary.
This goes way beyond electronic billing software. The system needs electronic health records, properly filled out, that network clinical data. That data can then be used to rate performance of specific treatments. With detailed analysis that only powerful computers armed with reams of data can do, combined with networked software deployed in every medical facility, doctors will be able to properly evaluate how effective each treatment has been in similar cases across the country.
Somebody Has to Say No
With all this expensive tech floating around, and a whole lot more on the way, someone is going to have to get courageous and make tough decisions about how and when it will be used, and on whom. Yes, it's rationing, but we already have rationing today. It's especially problematic now, because making the choices are corporate bureaucrats at insurance companies, who are motivated by profit, not by saving lives by using technology effectively.
If there must be hard choices made, those choices must be based on the probability of a positive outcome. That could be done effectively if there were enough data to sift through. This techno-triage is not going to be easy to implement in our society today, where it's taboo to put a price on someone's life, or a price on the technology that might be able to save it. Making matters even more difficult are hospitals and doctors who don't want facts to dictate which procedures to implement, because those medical profiteers can rake in more money by ordering more tests, procedures and surgeries.
Let's face it — health care will be rationed one way or another, and should be. When the U.S. political-medical-industrial complex finally gets honest about that, let's hope real information is used to make those decisions, rather than greed. Let's use technology based on how effective these tools are in certain situations to decide how to wield them. After all, technology doesn't raise health care costs — people do.
By Anonymous at 7:40 PM ON 08/20/09
I'm sorry, but people these days are much more hostile to "some Washington bureaucrat" rationing healthcare than the rationing that is already being done today-- by MMOs and insurance companies, raising premiums and deductibles and dropping coverage.
By murc at 9:42 PM ON 08/20/09
This is a touchy subject for some...
interesting article.
The one thing I am against is government run health care.
I doubt all hospitals and insurance companies are like you described. I don't think they are all greedy, I'm sure they all want to make a profit...which is good...that's capitalism at work.
I do think something should be done about health care...but there is nothing wrong with spending a few years in mulling over all the details
Theirs no reason to try and pass a multi-trillion dollar program in a weekend (I'm staring at you Obama).
By Chas at 1:29 AM ON 08/21/09
You know, I like your articles usually. For the most part you should probably stick to reporting on the technology, and not on how or when people should use it.
Not every use of technology on a patient is based on a profit motive, and yes, there are other ways to save that $2000 replacement of parts - with a much higher risk of infection in patients.
By John at 1:44 AM ON 08/21/09
I like this blog because it provides a daily escape from politics and standard news. Please keep it that way.
By CraigK at 1:49 AM ON 08/21/09
I think you have the right idea but treatment for a 95 old is a very small percentage. I work in the medical field and have relatives that do too. Hospital try to make as much money as possible. Every procedure is coded for billing. They might order several procedures even if not needed as long it is covered by insurance. The thing is people think the insurance companies will regulate this but to a point. The doctors and hospitals are also the insurance companies customers too. They have to allow them to make decent money. If they don't directors and doctors leave because it effects their bottom line which will effect their salary. In the end they pass the cost to us. It's a crazy balancing game.
Also 46 million, 15%, Americans are uninsured. If you are sick or hurt you go to the doctor. If you are uninsured you procrastinate until it's necessary because you can't afford it. Without early treatment where a simple prescription of penicillin could treatment, expensive surgery and hospitalization might be required. These debts don't get paid and get passed on to people who pay as part of the hospitals operating cost.
By CraigK at 1:51 AM ON 08/21/09
I think you have the right idea but treatment for a 95 old is a very small percentage. I work in the medical field and have relatives that do too. Hospital try to make as much money as possible. Every procedure is coded for billing. They might order several procedures even if not needed as long it is covered by insurance. The thing is people think the insurance companies will regulate this but to a point. The doctors and hospitals are also the insurance companies customers too. They have to allow them to make decent money. If they don't directors and doctors leave because it effects their bottom line which will effect their salary. In the end they pass the cost to us. It's a crazy balancing game.
Also 46 million, 15%, Americans are uninsured. If you are sick or hurt you go to the doctor. If you are uninsured you procrastinate until it's necessary because you can't afford it. Without early treatment where a simple prescription of penicillin could treatment, expensive surgery and hospitalization might be required. These debts don't get paid and get passed on to people who pay as part of the hospitals operating cost.
By Roffe at 9:54 AM ON 08/21/09
I agree that decisions on what treatments to give patients must be rational and based on scientific evidence. Anything else is a waste of time, money and resources (except in cases where evidence is lacking). The same goes for drug treatments; pharmacoeconomy is becoming an increasingly important tool for managing patient costs.
Whenever you read about some poor child with a deadly condition, finally receiving the treatment necessary to save his/her life (after being denied at first but then granted the treatment after the media whipped up a storm), I bet no one thinks about the patients who will be denied their treatment and will be forced to endure their condition which, although perhaps not fatal, probably involves a lot of suffering.
It's an extremely difficult choice to make, but budgets are limited and will remain so, until we switch to a system other than the monetary (Zeitgeist..)
By Anonymous at 11:10 AM ON 08/21/09
@murc: "The one thing I am against is government run health care." Why? Who else can objectively look at the health costs and reform the system? Aside government there are only two other parties left in the equation: patients/families (people will not be rational about their loved ones' life) or MMOs/hospitals/doctors (profit motive, they have no incentive to do anything that cuts into their bottom line.) Again I ask, who else can do it?
By Giggity at 11:15 AM ON 08/21/09
@CraigK ... you stated "Also 46 million, 15%, Americans are uninsured. If you are sick or hurt you go to the doctor. If you are uninsured you procrastinate until it's necessary because you can't afford it. "
While this is true, you also know that no hospital can legally turn you away if you dont have Ins.
I have worked with medical management systems for hospitals and private practices and I cant count how many people come in w/o Ins and skip the bill.
That cost is either written off or swallowed (by many private practices not really able to follow up on forcing payment) or covered by some kind of funding (usually hospitals or clinics can get this).
It still aint perfect...but everyone (including illegal immigrants) can get medical attention.
Its the payment for services rendered thats the real issue. If these practices and hospitals cannot cover the costs, then they have to start rationing and rejecting or eventually close down.
We are living longer, requiring more care and that leads to an unending rise in overall cost.
Dont even get me started on Pharmaceutical companies pushing drugs for every little thing. That just adds to overall cost.
By Giggity at 11:21 AM ON 08/21/09
@Anonymous...
I'm trying not to open up a big political discussion here, but...
A person or group can only be objective if they have absolutely no vested interest.
Unfortunately, there may not be any groups out there that can honestly claim that.
By Popster at 11:45 AM ON 08/21/09
The real culprit in the cost of medical care is over use of technology, tests, studies, and referrals to specialist. Cut that out and we may be able to save health care.
By Chas at 2:51 PM ON 08/21/09
Please, you all need to go out do some some research on the subject. Everything I see here is a result of soundbite politics you all are being fed. Right now you have major special interest groups trying to form the policy on this issue, and someone needs to get involved that has no vested interest in their issues, just the American people.
Technology saves lives, doctors save lives. You would not have X-rays today if not for people advancing technology to help with better treatments (all of which result from other research programs that in many cases have nothing to do with medicine).
The AMA artificially limits the numbers of doctors and specialists that are certified to practice medicine. Pharmaceuticals push to make sure Americans pay the cost for most medicinal research since we will pay more (why don't they want us monitoring pricing in other countries to set ours here?). Insurers are "for-profit" so they have an interest in making money on you, while paying as little for your care as possible. Government bureaucrats can't run a program without wasting money - and the unions (such as SEIU) see a golden opportunity to end up becoming "government" labor unions instead of medical provider unions.
These folks are not concerned about "Us". And for DVICE to spout their opinion (the result of some other soundbite politics) is sad. They should stick to reporting on the technology, not proselytizing on how it should be used.
Wake up folks.
By Gman at 2:57 PM ON 08/21/09
Coming from Canada and having a mother who passed away at 82 from cancer, basically because she was to old . Come on, how would anyone like to know when their old that they don't mean anything anymore and totally valueless to society, which is what government run health care leads to. Oh to add they had caught the cancer early, and would have been curable if they had just operated right away. Think about it does anyone wants to end their lives like that!
By murc at 6:51 PM ON 08/21/09
@ Anonymous:
good point and from that perspective it does make sense.
But for me its the simple fact that its another giant government program that will waste billions of tax payers money. 1/6 of all private business will become government run overnight.
Government run programs have zero incentive to cut waste, private companies have to so they can cut costs and stay competitive.
just look at all the government programs that are going belly up: Social Security, Medicare, Medicaid, USPS.
I think the government needs to shrink, not grow.
I was pulling for Romney in the elections...with Huckabee being my second fav. The thing that I really liked with Huckabee is that he wanted to get rid of the IRS, and replace it with the "fair tax", which essentially was a tax on consumers...but I dont want to dive into to many details.
The government is out of control, and the spending is insane, hence why the dollar has fallen so much.
2012 cant get here fast enough.
By DustMan at 10:53 PM ON 08/21/09
As someone who actually works in the healthcare finance field, I just want to address a couple of things, based on my experience:
a) By and large, Hospital don't want the newest fancy schmancy doodad that costs multiple millions of dollars. Most doctors don't really want them either. The biggest driver is the patient demands. Like most things that drive up medical costs, people think they need the absolute best, everytime, right now.
b) The biggest challenge to the accurate electronic medical record is training the doctors. Medical practioners, for the most part, are not the most tech-savvy people, with many of the older ones never having used a computer.
c) Any attempt to control healthcare costs that doesn't make the patient feel the cost of the care provided is doomed to failure. Any expansion of a public plan will only require more cost shifting to the insured patients to make ends meet. Until most people have to pay attention to their day-to-day healthcare costs, every fancy new toy will get bought and used, irrelevant of efficacy, over and over again, in fear of frivolous malpractice litigation, bad PR and the loss of business to competitors.
By drkmtch at 1:35 PM ON 08/22/09
This will be brief....no it will not. "SyFy" stay out of politics.
We need tort reform to reduce cost on medical care and a consumer reports style connection to medical procedures and pharmaceuticals. The govt. would like this social ideal to our medical system to have control of people by limiting health and knowing our condition.This will eventually involve an ID system that will be biometric and GPS responsive. Also by future biometric implants to track us which will be enforced. They want complete control over peoples ability to revolt. We are being put into a prison with no walls by giving total control over who live and who dies and who is aborted and who is not. It is the perfect elitist over consumer control system. Legislate control, Enact mandatory biometrics ID with fail-safe Kevorkian mechanism, kill all who oppose/revolt. Yes it is far fetched, but the end game extreme is, once the door is open a precedent is set and no extreme version can be stopped.
The answer to reducing health care cost has nothing to do with who is cared for and the government knowing and judging the livelihood of every consumer in the chain. Remove the sue happy lawyers, restore independent thought and freedom to a doctors prognosis and or give him a consultation forum to counsel better prognosis. Get pharmeceutical companies to stop bribing doctors to be pushers. Keep bureaucrats out of my wallet, medical records and families end of life decisions.
The communist/ socialists in our country need to be weeded out and downgraded for the weak belief system they are trying to impose on the majority. You are not the problem they are. If I don't do my job right I will be replaced with someone who will. If you see a socialist oppressing the capitalist view our country has dominated the world view with for the last 200 years. Do your best at removing them from power in the public eye. I suggest everyone who is in favor of government dominated society take a long hard look at who is near them with a capitalist view. You may be exiled from a capitalist job you work at when this fails. You may be exiled from all capitalist health plans, capitalist banks and capitalist living as you know it. As I reiterate, SyFy stay out of politics! And get some balls about the name too.
By dorkman at 1:00 AM ON 08/24/09
Get profit out of the patient/doctor relationship. Remove all 'For Profit" companies from the health care picture. Creating wealth from others medical needs is no way to drive an economy.
By menahunie at 6:58 PM ON 08/27/09
Yes we need medical ovehauled - even the obamacare. The problem you all miss is the cost; as one poster pointed out all the billing at overinflated priceing. Explain to me why in a hospital a tylenol, etc. costs around 10-20.oo PER PILL? Explain why an ace bandage costs around 50.00-70.00 in a hospital?? Drug companies pushing drugs; again why does a drug cost way way less in another country than HERE? Case in point many people were buying THE SAME EXACT DRUG ONLINE; CANADA, MEXICO WAY WAY CHEAPER EXCEPT NOW THE GOVERNMENT AT THE DRUG COMPANIES PUSHING OUTLAWED IT.....That is where the freaking problem is. Also all the comment about expensive testing done when it is not needed; who really decides that? I know who does... THE FREAKING LAWYERS DO.... The doctors are no to blames for all these tests they do; they are mainly trying to cover their butts from a malpractice law suit; which at times are justified; but all are people looking for that pot of gold at your and mine expense...
By Sasquatch at 1:04 AM ON 08/28/09
Well, I think that we should be using all of these gadgets no matter what. The problem is this. That those who design and build these gadgets put such a high price tag on them and doctors and hospitals put such high price tags on using them. So what if you give a heart transplant to a 95 year old man. He will survive a little while longer and every moment once you reach that age is precious, no matter what. If you can do this surgery without this fancy gadget, so what? If it will ensure that the surgery is more successful and with less chance for error than use it. anything that can help doctors and surgeons do their jobs better and make it so that they are successful in performing any type of surgery. Let them.......... dont blame the cost of medical gadgets on the rising cost of health care. That is bull, they put a high price tag on it when they dont need to. Much of this medical equipment that they claim is sooo much, is paid off in less than a year normally. after that, all the revenue from using those gadgets is profit. It is hospitals realizing they can make excuses as to why they have to charge so much and get more profits and it is the doctors saying they need more money when most of them make 6 figures a year anyway. They already made it so the RN's do most of the work anyway and the doctors get paid the big bucks for taking the credit and looking over the notes and making the final medical decision. If we want health costs to go down. We need to make the government regulate how much a hospital is allowed to charge for things. We need to have them regulate who makes medical equiptment and how much they sell it for. Those that do the research for the medical equiptment make decent money, those that fabricate and put together the equpitment dont make as good of money as the desigers do. then the companies sell the equiptment for an outlandish price and reap all the profits. It is crazy, it is greedy, it is wrong. that si the only way, becuase otherwise, it will just get worse and loopholes will be found to increase prices to offset losses and gain more profit.
By Andy at 12:51 PM ON 08/28/09
There's also stupid laws that determine it is monopolistic if one hospital in the city has an MRI (or other $$$ gadget)... the other hospital must now have one too since apparently sharing is not an option. Plus you get an insurance company saying they'll cover you at one hospital and not the other one two blocks away that has the only MRI in town.
By cruzer at 12:25 PM ON 08/31/09
This article highlights WHY we place such trust in Physicians - they have ALWAYS been charged with making Triage decisions and we should RETURN those decisions to the treating Physician! The best way to do that is to have a single payer system so that the "pure profit motive" behind every hospital trying to have every gagdet and using it on anyone they can, will by necessity go away. Hospitals will SHARE resources instead of duplicating them in order to maintain profits. This is a far cry from "Government Run", it is single payer which means the funds come in from everyone and go out for everyone- as medically necessary. Not all 95 year olds are the same just as all 12 year olds are not the same - hence, Medical practitioners and the hypocratic oath: "First, do no harm."
By ann safron at 8:55 PM ON 09/02/09
The system of capitalism relies on a free market and the ability to work with that market. Unfortunately, the people who work in this "free" market are far from perfect or sometimes even moral. Any system, political of healthcare will depend on the integrity of those who involved in it.
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