To solve a problem, we must first seek to understand it. Please read the enclosed article and give me your feedback in the office or via email. Following the link is a brief statement from a colleague that I think is right on.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all
Professionalism and High-Cost Health Care
By Stephen M. Perle, DC, MS
The June 1 issue of the New Yorker magazine has an excellent article about what drives up the cost of health care: “The Cost Conundrum: What a Texas town can teach us about health care” by Atul Gawande, MD. In the article, Dr. Gawande compares the cost of health care in McAllen, Texas, and in nearby El Paso. The two areas have basically the same demographics and health statistics, so it’s not the people. They both have similar healthcare technology, so it’s not the infrastructure. And their cost of living is about the same. Yet, McAllen’s Medicare expenses are about twice those of El Paso. The only city in America with higher medical costs is Miami, and it has a much higher cost of living (one would think the higher cost of living would lead to better health outcomes, but it does not). On the other hand, Rochester, Minn., home of the Mayo Clinic, has one of the lowest rates of medical costs per patient.
I suggest reading the article, but my take on it is very simple: The doctors at the Mayo Clinic live up to the moral principle that created the social contract whereby society grants autonomy to professionals (classically, this includes clergy, attorneys and those in the healthcare field). Society created the social contract because it lacked the knowledge needed to properly understand and regulate the professions. The contract states that professions receive autonomy to practice as long as they subjugate the needs of the profession and individual professionals to the needs of the patient, parishioner or client. The Latin phrase credat emptor replaces caveat emptor. The latter, we all know, means “Let the buyer beware.” The former, however, is “Let the buyer have faith”—faith that the professional’s recommendations are in the buyer’s best interest, not the professional’s.
What does this mean with respect to McAllen, Texas? Dr. Gawande’s research shows that the problem causing the inflated healthcare costs is an almost unconscious attempt by healthcare providers to avoid “leaving money on the table” by billing for everything possible—regardless of a patient’s actual need.
In the past, every study examining the cost of chiropractic care compared with medicine showed that we were a more cost-effective intervention. More recent studies have the opposite finding. For whatever reason, some in our profession have put their profit ahead of their patients’ needs. We must keep in mind that professionalism matters. Until the prevailing ethic among all healthcare providers (doctors of chiropractic included) stops being the health of their wallets and properly returns to patients’ health and the value patients receive from our care, no effort will reduce costs and increase health and wellness.
Dr. Perle is a professor of clinical sciences at the University of Bridgeport College of Chiropractic, where he has taught an ethics course for more than 15 years.
