As a clinical ethics consultant and bioethics professor for many years, it still amazes me that one of the most common problematic features of our healthcare system is the tendency to over treat patients to the point of causing harm and wasting financial resources. The question is, why?
The question, why do physicians generally over treat patients in the U.S., must be approached in light of the fact that we spend more per capita and more overall, about 16% of GDP, on healthcare and get far worse outcomes than do countries like Canada and Western European countries who spend far less of their GDP on healthcare. But to be fair, before we blame physicians entirely for making poor judgments about treatment options, it is important to keep in mind that the U.S. is big, diverse nation with complex social and economic issues where creating efficient systems of healthcare is both practically and politically challenging. Also the U.S. spends more on medical research than most other countries, which still benefits patients everywhere. But what is most uniquely American is an economic system designed by politicians first and foremost for creating wealth for investors and that provides, generally speaking, efficient markets for consumer goods and services. But, whatever the virtues of American capitalism in creating efficient markets, it does not hold true for healthcare.
It has been known for sometime that a large portion, perhaps up to 1/3 of what we spend on healthcare, does not improve the quality of care for patients. The central reason that is often given to explain this pattern is the way physicians get reimbursed for providing services—the more procedures they perform, the more revenue they generate.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.