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Trying to avoid overuse, underuse of medical care

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In this Modern Healthcare interview, Vikas Saini, M.D., president of the Lown Institute,  the healthcare think tank and reform organization, discusses the need to involve patients in decision-making and how to avoid overuse and underuse of medical care patient by patient and achieve “right care”.

He notes:

“The real strength of the “Choosing Wisely” initiative has been clearly establishing the principle that there’s a lot we do for which there’s no evidence and there’s no benefit, and so if you do it, you’re only asking for harms. You’re only asking for either complications or side effects, or waste of money. The broad question is how do we deliver the right care? We came up with close to two dozen or more drivers (of inappropriate care). And these drivers act in complicated ways.”
Then he explains how.On the Affordable Care Act he says:{A} big part of what’s happening with the ACA is that the affordability of insurance on the exchanges depends on a mechanism of high copays and deductibles, which means that patients are being put in the position of having to figure out whether the extra cost to them for any given visit or test or procedure is worth it. I don’t think our patients and communities really have enough knowledge and understanding to make that decision. I think it’s unfair to do it that way. There is a theory that if people have skin in the game, they will make better choices. In healthcare that may be true, but it’s true at the margin if you have the leisure of thinking about it.”
“….Too much of what we do and the kind of interactions we have and the kind of decisions patients have to make, they’re not equipped to do. So what we’re really doing is shifting the cost. Certainly aligning payment incentives is a help. But we can’t succumb to magical thinking that by aligning payment structures things will get better.”

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