There’s the low-value care: things like C-sections, and pre-operative tests for low-risk surgeries. Then there’s high-value care: statin use for patients with cardiac risk, vaccinations for children, and comprehensive diabetes care.
As Michael Hiltzik notes in the Los Angeles Times, intelligent health care consumers would utilized high-value care 100% of the time, low-value care 0% of the time. Hiltzik, riffing on data provided by researchers in a working paper, says that doctors are only a little more likely to be steered toward choosing the right sort of care through high deductibles and cost sharing than non-physicians.
“The finding is important because it suggests there’s a limit on how much more efficient the health care system can become by making consumers better informed,” writes Hiltzik. “If doctors, the best-informed medical consumers, can’t consistently be steered to the most cost-effective treatments, then obviously average consumers will do much worse.”
That isn’t to say that deductibles and co-pays should be done away with. Jonathan Gruber of MIT and one of the authors of the working paper, tells Hiltzik.
“The right answer for our system is not to tell patients they can’t have service X,” says Gruber, “but to say service X isn’t cost-effective—if you want it you have to pay for it. That’s controversial and hard, but the lesson from this paper is that we should bring expert analysis into cost sharing, rather than relying on consumers to figure it out.”