Cooperating for better care.

Gilbert Welch

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Guidance on reducing unnecessary care


In a Baltimore Sun Commentary piece headlined “The myth of more medicine and better health,” Dan Morgan, M.D., gives some advice toward the end of the piece:

“Although there are many factors promoting overuse {of medical care} there are a few things clinicians and patients can do to limit unnecessary care. Clinicians can educate themselves to the problem of overuse and become more thoughtful in how they use tests and treatments. Physician groups have determined lists of over 250 current practices that should not be done. The British Medical Journal has a section ‘Too Much Medicine’ and JAMA Internal Medicine has a ‘Less is More’ section, including a yearly clinician ‘update’ on practices to reconsider. Physician groups educate on ‘Right Care’ or ‘High-Value Care.’ Likewise, it is important for patients to educate themselves. Consumer Reports has a Choosing Wisely series for patients describing key types of care to avoid, and books by the Dartmouth primary-care doctor Gilbert Welch or journalist Shannon Brownlee are readable and informative.”

Gilbert Welch touts the simplicity of single payer


“Our current system of multiple payers is supposed to foster competition, which in turn is supposed to make health care more affordable, more accessible and have higher quality,” writes Dartmouth’s H. Gilbert Welch, M.D., in a CNN opinion piece. “How could a single payer ever improve on that?”

Easily, writes Welch, a professor of medicine at the Geisel School of Medicine and atThe Dartmouth Institute for Health Policy & Clinical Practice.

“First, multiple payers multiply the complexity for patients,” he wrote for CNN. “Sure there are many choices, but patients may not understand the tradeoffs involved—often because they have incomplete information (Exactly who is in-network anyway?). While there may be some who enjoy all these choices, they are overwhelming for many.

“And for those who might be eligible for financial assistance, there is another set of hurdles in simply determining their eligibility (What will your income be?). These hassle factors loom particularly large for those who have little immediate motivation to care about insurance—the young—the very group we’d most like to have it.

“With a single payer these complexities disappear: Everybody is in, nobody is out.”

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