How to drive down health-care costs: treat people like dogs

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There’s a piece by a veterinarian in the current issue of Newsweek that makes the case for structuring the human health-care system more like the one we have for animals. That doesn’t sound like a completely ridiculous idea to me.

Naturally, there are big differences. Very few animals are covered by health insurance. Veterinarians can’t get sued for millions of dollars when a patient dies. As attached as we are to our Fidos and Fluffies, we can still go down to the animal shelter and pick out a replacement.

But there are lessons to learn. Including this one:

While pet insurance exists, only roughly 3 percent of owners carry it; even then, clients pay a substantial portion of costs themselves. That means they usually want to know the rationale behind each test. I explain what I think is going on, what I want to look for, and which tests I need to perform to find it. I rank the diagnostics from most to least essential and lay out approximate costs. My clients then choose what they want done, with an understanding of the relative importance, risk, and cost of each option. This step-by-step approach may seem time-consuming, but it dramatically reduces the number of expensive, unnecessary tests. And the process is more gratifying.

When facing the death of a loved one—human or animal—the real challenge is coming to grips with the reality of the situation. Since my approach draws me closer to families, it’s easier to suggest that the best course of treatment may be relieving pain rather than fighting a disease. Owners are less likely to fear that you’re giving up on their beloved pet if they trust you. When I’m asked about performing tests, and I know the results won’t change the outcome, I say so.

As you may recall, I’ve taken to talking about price tags for health care. Let people see what everything costs, and then have them decide what’s really worth paying for.

Behind that push for price transparency is a broader construct about individuals’ place in the health-care system. The thing I’m really talking about, which this veterinarian is too, is treating people like customers instead of like patients.

I am a huge fan of these videos, produced by the Agency for Healthcare Research and Quality (AHRQ), which get at the fact that people rarely ask their doctors enough questions about what’s going on. I’m guessing that AHRQ cares more about patient safety than driving down health-care costs, but I don’t see why a new culture of patient-as-consumer couldn’t do both.

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