Once people understand the magnitude of harmful or wasteful care, they are much more willing to support interventions to curtail unneeded care through greater physician oversight and possibly increased patient cost sharing, according to a new report, Doing What Works, from the nonprofit Center for Healthcare Decisions (CHCD).
By some estimates, up to 30 percent of all care in the United States is at best ineffective or at worst harmful to patients. To address the issue, California’s three largest health care purchasers—the state Department of Health Care Services (DHCS), which administers Medi-Cal; Covered California, the state’s health insurance marketplace; and the California Public Employees Retirement System (CalPERS)—in 2015 formed the Statewide Workgroup on Reducing Overuse with an explicit mandate to gather public input on how to address the problem.
The Doing What Works project assessed public views and values through public deliberation—a proven way of convening citizens to consider an ethical or values-based dilemma and then weigh alternative, often competing, views to gather informed public input. CHCD conducted 10 intensive half-day deliberative sessions from September to December 2015 with 117 California residents with Medi-Cal coverage, as well as lower-to-middle income health plan members from Covered California and CalPERS, to answer the question: “What strategies are most acceptable for reducing the use of medical care that is harmful and/or wasteful?”
Participants received factual background information about overuse of three common medical services—antibiotics for adult bronchitis, C-sections for first-time normal pregnancies and MRIs for common low back pain—and then discussed options for reducing inappropriate use.
While participants recognized that patients sometimes insist on unnecessary care, they believe physicians have a responsibility to say ‘no,’ when care is inappropriate. Among the Doing What Works findings and recommendations, participants:
- Supported monitoring physician practice and taking steps to change physician behavior.
- Agreed that penalizing doctors by denying payment for inappropriate or unnecessary services should be used as a last resort.
- Believed that patient choice is important but not if services are medically unnecessary, cause medical harm or pose an unneeded cost burden to others.
- Want to see greater visibility of overuse problems: both the medical harms to patients and the waste of money that affects everyone.
The findings echo the results of an American Institutes for Research study recently published in Health Affairs exploring how public deliberation can increase public understanding of medical evidence and advance acceptance of evidence-based care. Titled “Understanding an Informed Public’s Views on the Role of Evidence in Making Health Care Decisions,” the study found that when people had the opportunity to learn about and discuss medical evidence through public deliberation, their views shifted toward giving more weight to medical evidence and less to patient preferences.