NEJM article: Media partially to blame for slow adoption of cost-effective health care

In a new “Perspectives” piece in the New England Journal of Medicine, Victor R. Fuchs, Ph.D., and Arnold Milstein, M.D., M.P.H., examine why cost-effective health care has been slow to catch on in the United States.

They point to a number of factors, including insurance companies’ desire to protect profits, large employers that don’t want to alienate employees, legislators who collect campaign contributions from the health industry, hospital administrators protecting their revenue, doctors who are generally resistant to change, manufacturers that fear losing market share and more.

The authors also point blame at the media, saying it doesn’t adequately explain who really pays for health care:

Great harm is done when employment-based insurance is discussed as if it were a gift from “generous” employers rather than an alternative to wage increases.

They also mention a topic that is surely familiar to Covering Health readers: relative risk vs. absolute benefit.

The media also mislead the public by emphasizing the relative benefit of clinical interventions (“reducing risk of death by one third”) when the absolute benefit (“reducing risk from 0.03 to 0.02”) is usually more relevant.

“Misleading headlines, designed to attract larger audiences,” also get a share of the blame.

What do you think? Does media coverage have an effect on how cost-effective care is accepted? If so, do you have suggestions on what reporters could do differently?

5 thoughts on “NEJM article: Media partially to blame for slow adoption of cost-effective health care

  1. Elaine Schattner, MD

    Good topic. I’m sure we’d all agree that media sources vary – widely – in how they cover medical progress and “evidence.” Doctors are responsible, too: Only some read carefully about new developments from unbiased sources (if such exist) before conveying information to patients.

    What would help both media and physicians, of course, would be clear data. Unfortunately, that’s still lacking for an astonishing number of common conditions and old medicines, no less for new treatments in individuals with complex disorders and more than one diagnosis.

  2. Karla Gale

    The NEJM article merits a response highlighting organizations like AHCJ and HealthNewsReview that educate journalists in data interpretation and how to spot research inadequacies and conflicts.

  3. B. E. Robinson

    The root cause of overexpensive, underperforming care is a public that wants all the medical “bells and whistles” when it is their turn, as they have come to believe what they see in print and video: that the right doctor, medicine, or hospital can fix anything. As such care is expensive, they also need for someone else to pay for it. US health care is oversold and overblown to the point of a national religion, in which we believe against overwhelming evidence that our healthcare is the best, and no one need sicken or die. Media efforts to create rational expectations would be useful: how about a prime time reality series of people with serious diseases who spend small fortunes on unimportant care, and then die? There is no shortage of material.

  4. Nash Gabrail MD

    The article by Milstein, in a concise way encapsulated the ailments of our health care system. Contrary to the common belief we dont have the best system, our health care “industry” is based on grab what you can as long as some one is willing to pay. I have come to the uncontested conclusion that the insurance industry is not interested in loweringhealth care cost, they profit on margins and that will be especially critical in the health care reform since their margin cant exceed 15% of the total premium cashed.
    Market forces have never been in play in health care because those who pay are not the employers, it is the insurance companies that pay and the employers have to suffer the annual increases in premium because the cost is rising.
    Employers feel that they have no recourse, they are told by their insurance carriers that the cost is inevitably rising, basically deal with it… and they do.

    Capitalistic market forces can onl work if the entity that ultimately pats the tab is in cahrge of utilization. Even with the Third Party Administrator “TPA” system the employer has little say in rationing utilization or monitoring providers utilization. There is little incentive for the TPA to cut cost, their revenues are based on a flat fee or a percentage of the total cost, either scenario is hardly an incentive for cost containment. All employers are doing is shiftig some of the cost to the employees, a good business strategy but only only for the short term.
    It is time for the employers to be in the driver seat, they pay the bill and they should not only have a say but decide on who the provider should be and weed out the expensive ones. If a hospital or a physician is found out out to be inefficient the employer should have the abilit to disincentivize them from the plan and there are ways to accomplish that.
    Most employers especially large ones “except the government” are potentially able to do that effectively. Most employers are cost efficient and care for their cash flow with one obvious exception, the govenment. that is why the government is not the solution. it is and has been the problem and will continue to do so.

  5. Lani Luciano

    Since the early days of outcomes research in the ’80s, the media nurtured and exploited the public’s fear that more care is always better and less is always worse. (“The HMO Killed My Baby”) Efforts to measure effectiveness – much less cost-effectiveness – were, and still are, denounced as rationing. (Donald Berwick) It’s tough for the health care system to sell what the public isn’t buying.

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