“Trust
but Verify.” Verify?
Answers
to two basic questions could provide major momentum
toward reforming America’s health care system.
The first is: Who do we trust?
The second is: How do we verify that trust?
We tend to trust most the people with whom we have the
most face-to-face, human contact. So we are more likely
to rely on physicians, whom we assume are competent until
proven otherwise than we are on faceless bureaucracies
like our government and health insurers, whose primary
concern seems to be saving money, possibly at our expense.
This response defies the logic of science, which tells
us that aggregating large amounts of data can determine
what works best to prevent and treat disease. Government
agencies and insurance companies have useful data that
we tend to ignore as we “consider the source.”
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Jessie
Gruman
President
and Executive Director
Center for the
Advancement of Health
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We
acknowledge that doctors are part of the nation’s
economic elite but we tend to ascribe purer motives
to them. Some of us simply can’t believe
that our doctor might be simultaneously doing
well while doing good — for example, performing
expensive procedures that aren’t absolutely
necessary.
Most doctors have little incentive to minimize
costs. If they can make things 2 percent better
by recommending something that doubles the cost,
there’s a good chance they will do so in
their quest to deliver the best for their patient.
They tend to share patient ignorance about what
things cost.
Health reformers acknowledge our biases about whom
to trust when they say that we patients should
level the playing field and shop for the best doctor
and health plan, just as we do when making other
important purchases. That’s an appealing
but unrealistic argument. Most of us lack the skills
required to make such a sophisticated decision
about our health care choices. And so far, no one
is providing us with useful tools that would enable
us to do so.
We keep hearing that help is on the way in the
form of physician, health plan and hospital quality
ratings relevant to our personal decisions, but
few truly helpful ones have yet to materialize.
And we’re denied easy access to even the
most basic information about the price of specific
services.
But these are only part of a more complex process:
when we shop for health care services, we are looking
for trusted agents -- individuals and organizations
-- with the knowledge, experience and skill to
ease our pain and cure our diseases.
Breathless news reports about medical errors, unsafe
hospitals and physicians ambivalent about evidence-based
medicine may make some wary but for the majority
of us, the absence of any real way to make sure
that those who deliver our health care are trustworthy
leaves us resigned to whatever plan is cheapest,
whatever doctor we are referred to, and whichever
hospital she is affiliated with.
Many health reformers believe that people will
engage in their health care only when they realize
the dire consequences of not doing so. I fear that
continuing to sound that alarm without providing
the tools that will make people confident that
that they can make good choices about their care
will result in an erosion of trust in health professionals
and institutions – thus undermining the belief
that there is anything that we can do to ensure
that we can find care that will make a difference
to our health and our lives.
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The Health Behavior News Service regularly distributes
stories summarizing new research on health behavior
issues. These stories can be found online at http://www.cfah.org/hbns/current.cfm.
Here
are some stories released in December:
Obesity Leads to More Hospital Admissions, Longer Stays
Obese adults are admitted to the hospital more frequently and for more days than
adults who are normal weight, finds a new study that looks at how being obese
leads to a need for more health care services.
Study Links Sex Education to Delayed Teen Intercourse
Sex education greatly boosts the likelihood that teens will delay having intercourse,
according to a new study that is the first of its kind in years.
Poor, Uninsured Perceive More Discrimination During Health Care Visits
For many Americans, poverty and lack of health insurance make it difficult to
get necessary health and medical care. According to a new study, once they do
visit the doctor, poor, uninsured people often report racial discrimination when
communicating with health care professionals.
Childhood Cancer Survivors Catch Up in School, Work as Young Adults
Young adult survivors of most types of childhood cancers catch up educationally
and occupationally with their peers who have not had cancer despite time lost
to treatment, say the authors of a new study.
Veterans With Cancer Might Fall Under Radar for Depression
Veterans with cancer sometimes do not undergo depression screening — a
first step in easing the turmoil of possibly their hardest-fought battle.
Creative Work Has Health Advantages, Study Suggests
Employees who have more control over their daily activities and can do challenging
work that they enjoy are likely to be in better health, new research suggests.
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