Public Perceptions of Care Necessity

People promoting various health care innovations often talk about all the wasted spending there is, and how their innovation will reduce that wasted spending.  A lot of the unneeded cost is said to come from care that is inappropriate, or not consistent with evidence-based medicine, which in turn is said to be caused by fee-for-service medicine, which creates incentives for physicians to deliver more care.  I am not sure how much of all that chain of reasoning is true, but the public has apparently adopted the theme.  A new poll out of the University of Michigan’s Institute for Healthcare Policy and Innovation finds that older Americans think a lot of unnecessary care is ordered by doctors.   (UM Poll)   The National Poll on Healthy Aging asked about 1500 adults aged 50 to 80 years old what their views were on the topic.  When asked if more medical treatment is usually better, 43% of respondents disagreed, the same percent were neutral and only 14% agreed.  But they often believe their own providers may order too many services.  54% said that in general physicians often order services that aren’t needed and 25% said that they think their own doctor may order tests, medications and treatments that are unnecessary.  17% said that they specifically felt that in the last year a test, drug or procedure had been recommended for them that they did not need. Tests and medications were more likely to be perceived as unneeded than procedures.  Notwithstanding their reservations, 50% of these respondents went ahead with the test and 41% filled the prescription medication anyway.  On the flip side, 9% of respondents reported that their doctor advised against a medication, test or procedure that the patient thought was needed.  I am sure that there are some physicians who over-order treatments and tests and who do so because of financial incentives.  But I suspect more are worried about missing something or getting sued.  And I think more that this poll reveals, patients, and especially for older consumers, informal caregivers, push for treatments and tests that may not be needed, and doctors usually feel pressure to respond positively to patient requests.  So while it can be helpful to limit physicians’ incentives or reasons to prescribe unnecessary care, it is equally important to help patients accept physician decisions and not pressure for unneeded treatment.