A recent article (politico.com) discusses a number of important issues regarding the unique health care needs of the aged.
The overall framework of the article is that, in the case of health care for the aged, “less is more.” The points raised in this article should be considered by anyone with an interest in those covered by Medicare:
• It is estimated that a significant portion (between 25 percent and 33 percent) of health care services provided in the U.S. are unnecessary. Unnecessary care has both financial and health implications. The financial implications are straightforward – eliminating unnecessary care could help reduce the cost of healthcare in the U.S.
However, unnecessary procedures and medications also pose an extra threat to the physical wellbeing of the elderly. As noted in the article, older patients are also more likely to suffer harm from things like drug side effects and surgeries that go wrong.
In effect, less care and better care may actually be the same thing. This is particularly true in treating the elderly. But, it will be challenging for this notion to gain acceptance.
• Any movement to “slow down” medical care for the elderly – to thoroughly assess the special pros and cons of additional tests and procedures, to more aggressively prevent unnecessary care, and to think more holistically about the unique needs of these patients – runs into resistance from a number of sources, including payment systems, physicians, and patients. In effect, the United States has institutional and cultural forces that make it hard to say “no” to more medicine.
• On the other hand, there are a number of sources advocating that physicians can improve care by doing less. For example, a number of clinical and pharmaceutical societies have created lists of five to 10 things that their members shouldn’t do—at least without further conversation with their patients.
And geriatricians (who specialize in treating the elderly) understand how much harm can be caused by unnecessary care and by treatments aimed at specific maladies and not the whole patient.
There are many structural and cultural factors that can lead physicians to recommend care that is, in reality, unnecessary. Resisting these factors may save both money and patients.