Patients’ expectations add to costs of care, doctor says

The problem with trying to control the rising cost of health care by using the best scientific approaches – from evidence-based medicine, to wellness programs, to electronic medical records – is that many people expect more than the best that science has to offer.

Dr. Pablo Rodriguez, managing partner of Women’s Care Inc., an ob-gyn practice with offices in Pawtucket, Providence and Warwick, offered this view at an “executive forum” sponsored by Bank Rhode Island on Nov. 2 at the Squantum Association in East Providence.

Rodriguez said patients come to appointments armed with information from the Internet, newspaper articles and conventional wisdom. Yet because they don’t know everything they need to know, they often want more or different care than they actually need.

“If I practiced evidence-based medicine always,” he said, “I would lose all my patients.”
BankRI is hosting forums on business topics as part of its 10th anniversary celebration. To discuss health care, it invited Rodriguez, along with Laurie White, president of the Greater Providence Chamber of Commerce, and Dr. Gus Manocchia, senior medical director of Blue Cross & Blue Shield of Rhode Island.

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Manocchia cited research showing that, if best-practice medical treatments were used consistently, health care would be more efficient and less costly. But according to a Rand Corp. study in 2005, those best practices are followed only 55 percent of the time.
From a Six Sigma perspective, he said, airline baggage handlers provide a higher level of service, in general, than the nation’s health care system.

And White noted that rising costs are limiting access to health care as premiums increase and many employers reduce or drop coverage, in contrast to Rhode Island’s traditionally generous employer benefits culture.

The problem, said Rodriguez, is that consumers care about outcomes, employers focus on costs, and insurers look to limit their exposure and increase efficiency, so the three parties are not driving the public discussion in the same direction. “Your expectations are different depending on who you are,” he said.

In order for medical attention to be delivered correctly, Rodriguez said, those three aspects need to be aligned. Otherwise, “you can work around the edges with price issues, but that will only exacerbate the problem.”

BankRI President and CEO Merrill W. Sherman wrapped up the forum by sounding a call for action and leadership within the state. She noted that Blue Cross’ market dominance in Rhode Island creates a simpler environment for effecting real change in the health care system.

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