MEDICAL MATTERS:US experiment shows how much can be saved, writes MUIRIS HOUSTON
HEALTH CUTS are, unfortunately, something we are going to have to live with. The most dramatic recent example is how quickly the Fair Deal scheme ran out of money earlier this year.
There is growing evidence that the lowest hanging fruit has already been quietly pruned from the health service tree: important community care services such as incontinence wear, aids and appliances for independent living and home care hours are now much more difficult to access.
According to the recent Tasc report, Eliminating Health Inequalities – A Matter of Life and Death, “regressive budgetary measures over the past three years have had a disproportionate impact on low-income groups.
“These measures will contribute directly to higher levels of poverty and deprivation – and thus to increased health inequalities.”
In other words, and perversely in terms of need, health funding cutbacks target those in the lowest socioeconomic groups.
How much better (and equitable) life would be if budget cutbacks could be targeted sensitively so as not to adversely affect patient care. Can it be done? Well, the answer, appropriately from the US, is: yes it can.
Last month, the National Physicians Alliance in the US issued a number of recommendations for family doctors on how they could cut back on some common medical activities and achieve substantial costs.
The alliance, whose aim is to achieve high quality affordable healthcare for all, set up working groups to identify wasteful practices in primary care medicine. This is what it came up with:
Don’t routinely order X-rays for lower back pain within the first six weeks of symptoms.
Don’t routinely prescribe antibiotics for mild to moderate sinusitis unless symptoms last for seven days or worsen after initial clinical improvement.
Don’t order annual electrocardiograms (ECGs) or any other cardiac screening for asymptomatic, low risk patients.
Don’t perform cervical smear tests on patients younger than 21 years or in women who have had a hysterectomy for benign disease.
Don’t use Dexa screening for osteoporosis in women younger than 65 years or men under 70 years who don’t have risk factors.
The stimulus for the alliance’s work was a challenge laid down in the New England Journal Of Medicine last year by medical ethicist Howard Brody, calling on doctors to contribute to health reform in a practical way.
Welcoming the alliance’s recommendations, Brody said they were politically important because opponents of health reform have tried to paint cost controls in a negative light. Indeed, rather than something that was in danger of coming between the doctor and the patient, he said the suggestions represented the best of medical professionalism.
Spokesman for the alliance, Dr Stephen Smith, said: “We wanted to come up with the top things that primary care physicians can do that would enhance quality, but also reflect the idea of being good stewards of finite medical resources, save money and reduce harms and risks.”
It would be interesting to see how much could be saved here in Ireland by implementing the suggested changes. And it would be even more interesting if every specialty in the country came up with five recommendations for its area of expertise, given the much higher costs that exist in the hospital sector.
Unregulated screening is an area that could also be tackled, although it is more a feature of private healthcare. Whole-body MRI scans on perfectly healthy people is very hard to justify in terms of medical need.
Apart from the avoidable cost, the radiation dose of such an extensive scan is the equivalent of 100s of chest X-rays which one expert claims could increase the risk of a fatal cancer developing by one in every 2,000 patients screened.
But back to the inevitable cutbacks that lie ahead. Is there a group of doctors out there willing to run with the National Physicians Alliance idea and develop it in an Irish context?