November 2007
Treatment traps to avoid
Insured? You're money in the bank to the health-care system
“There was nothing wrong with me,” said Ron Spurgeon, who received unnecessary heart bypass surgery. “They took away my trust
in doctors.”
Photo by L&M Photography
Ron Spurgeon's health began to unravel when he hurt his shoulder doing yard work. He eventually wound up at Redding Medical
Center in northern California, where a cardiologist told him he had a life-threatening heart condition. Four days later, he
had triple bypass surgery.
Restrictions on heavy lifting as a consequence of the incision in his breastbone led the robust 56-year-old to give up his job maintaining machinery at lumber mills.
In 2003, two years after his operation, Spurgeon learned that Tenet Healthcare, the hospital's owner, had paid $54 million to settle U.S. government allegations that it billed Medicare for unnecessary heart procedures. The next year, Spurgeon and 344 others sued the hospital and eight cardiologists and surgeons for performing unnecessary procedures. The defendants ultimately paid $442 million to settle the suit, and Tenet says safeguards are now in place. Outside experts who reviewed patient charts determined that Spurgeon was among the many patients who hadn't needed their procedures.
"There was nothing wrong with me," Spurgeon says. "Those guys violated me. They took away my trust in doctors."
Spurgeon's story is an extreme example of a major, if unheralded, reason that medical care is more expensive here than anywhere else in the world: overtreatment and overdiagnosis, driven by the system's dysfunctional profit incentives.
As we reported in September, the ability of insurance companies to slow the growth of medical costs has deteriorated sharply since around 2000. The annual U.S. health-care bill has risen to $2 trillion, its highest point in history.
Topsy-turvy financial incentives are almost everywhere in the system:
Consumers already suspect the system is rigged against them. In a series of focus groups we conducted over the past summer
in Connecticut, Iowa, and Texas, participants told us they believed the system was designed to make money for doctors, hospitals,
insurers, and drug companies rather than provide high-quality care.
Our investigation can help you become a smarter and healthier consumer of medical treatment by recognizing the ways the system runs up cost and runs down quality.
Restrictions on heavy lifting as a consequence of the incision in his breastbone led the robust 56-year-old to give up his job maintaining machinery at lumber mills.
In 2003, two years after his operation, Spurgeon learned that Tenet Healthcare, the hospital's owner, had paid $54 million to settle U.S. government allegations that it billed Medicare for unnecessary heart procedures. The next year, Spurgeon and 344 others sued the hospital and eight cardiologists and surgeons for performing unnecessary procedures. The defendants ultimately paid $442 million to settle the suit, and Tenet says safeguards are now in place. Outside experts who reviewed patient charts determined that Spurgeon was among the many patients who hadn't needed their procedures.
"There was nothing wrong with me," Spurgeon says. "Those guys violated me. They took away my trust in doctors."
Spurgeon's story is an extreme example of a major, if unheralded, reason that medical care is more expensive here than anywhere else in the world: overtreatment and overdiagnosis, driven by the system's dysfunctional profit incentives.
As we reported in September, the ability of insurance companies to slow the growth of medical costs has deteriorated sharply since around 2000. The annual U.S. health-care bill has risen to $2 trillion, its highest point in history.
Topsy-turvy financial incentives are almost everywhere in the system:
- Doctors and hospitals profit by overpromoting and overusing unnecessary, unproven, and in some cases downright harmful tests
and treatments.
- People who live in regions of the country with an oversupply of specialists and hospitals are subjected to unnecessary treatments
and procedures that in many cases make them sicker.
- Drug companies are spending billions to promote costly new drugs that are often no better than older, cheaper drugs with a
proven safety record.
- The payment system discourages simple, low-cost counseling, care coordination, and treatments proven to save lives and reduce
suffering.
Our investigation can help you become a smarter and healthier consumer of medical treatment by recognizing the ways the system runs up cost and runs down quality.
