NEJM Audio Summary - Feb 16, 2012

Excerpted Script

"What We Talk about When We Talk about Health Care Costs", a prospective article by Peter Neumann from Tufts Medical Center, Boston. New ethics guidelines from the American College of Physicians calling for physicians to practice “parsimonious care” have reignited a debate about the role and responsibility of physicians in addressing problems with health care costs. The ACP argues that the guidelines will help physicians to consider more carefully the tests and treatments they order and prescribe for patients and to think on a higher level about the well-being of the community at large. Others have balked at the term “parsimonious,” viewing it as implying that care should be withheld and that society should be stingy about how resources are allocated for health care. The debate reflects the larger struggle in the United States over how to deal with — and talk about — health care costs. Research has revealed nonadherence to clinical guidelines, variations in practice patterns, preventable errors, and unnecessary hospitalizations. There is an overwhelming case for being smarter about how we finance and deliver care. The problem is that no one in charge seems willing to acknowledge that getting a handle on cost growth will also involve uncomfortable trade-offs. Rarely is there any mention that we will have to face hard choices and in some cases make do with less: patients with fewer services, more cost sharing, and restricted alternatives and physicians and hospitals with less revenue. The challenge is how to have a more honest conversation.

ACPの新しい倫理指針に“parsimonious care”という言葉が使われたことが論議を呼んでいるらしい。借金してまでも次々と車を乗り換える一方で、医療費はもったいないでは、市場主義のプリンシプルに自家撞着している気もする。