Why More is not Necessarily Better

In a recent post, I addressed the problems associated with the overuse of medical procedures and studies made available by less invasive and safer technology.

Clearly, these are cases where more treatment is not better treatment. There are numerous examples proving that the focus on more medicines, procedures, lab studies, etc. as part of the treatment plan to control a disease rather than a strong emphasis on prevention to create wellness and health substantiate my belief that more is not necessarily better, but in fact is often far worse.

Although there are many scenarios that could be described to support this hypothesis, the most obvious are smoking, obesity and excessive drug and alcohol use.

Although we have known for years that smoking leads to disorders ranging from mild shortness of breath to virulent emphysema and lung cancer, we continue to provide misaligned incentives that do not inspire true change, as reimbursement is still provided for the treatment of the diseases rather than rewarded for removing the cause. If working with a patient on smoking cessation therapies including medication support was reimbursed at even 10 percent of what a cancer treatment plan costs, I am sure there would be significantly less smokers in the world, particularly if the patient and provider were both reimbursed an additional amount of money for every year the patient continues to not smoke.

We are also all familiar with the myriad illnesses that are caused or exacerbated by obesity, the number one health malady in the world. (I’m sure many of you heard of a study by the Trust for America's Health and the Robert Wood Johnson Foundation last week that reported that in 31 states, more than one in four adults are obese.) But rather than seriously encouraging both the patient and provider to focus on fixing an obesity problem, we provide more and more medicines and therapies to treat the resultant pedal edema, congestive heart failure and uncontrollable diabetes. We use more and more supply and labor, spending more and more money with little benefit. Again, what if the rewards for removing the cause were greater than those for stabilizing the resulting chronic disease?

Trauma, which was the leading cause of death in children 7-years-old and younger 25 years ago to the leading cause of death in people 52 years and younger today. I believe this statistic will reach 60 years by 2020. Trauma care is among the most complex and expensive to provide, and is often poorly reimbursed. We know that drug and alcohol usage accounts for the majority of traumatic events we treat in our Emergency Departments. Again, if some of the resources we applied to each trauma victim could be shifted to alcohol and drug prevention programs (which are much less costly), and like smoking, rewarded annually if relapses to do not occur, would we not have a better, less traumatic world in which to live?!

Yes, these are clear examples where we apply more and more of our resources daily which have no long-term benefit. To be successful, health care reform must realign incentives so that “less” at times will be embraced as better!