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When high-tech medicine costs more, it should deliver

Post by TNT Editorial Board / The News Tribune on March 21, 2013 at 5:45 pm |
March 21, 2013 11:43 am

This editorial will appear in Friday’s print edition.

A recent Time magazine article on the cost of health care points out that while the United States spends twice as much on health care per capita as most other developed countries, we have the same or worse outcomes. One reason is that we don’t understand what we’re buying, writes Steven Brill in “Bitter Pill: Why medical bills are killing us.”

Take this scenario, for instance. Facing surgery, you have a choice between two procedures: One has been done for years with a certain level of success while the other uses a high-tech robotic system and has much the same success rate.

The main difference, which consumers with good health insurance might never be aware of: The latter procedure can cost at least $2,000 more.

The procedure in this scenario is a hysterectomy, the removal of a woman’s uterus. While about 65 percent of hysterectomies are still performed using a large abdominal incision and require lengthy recuperation, many women today are encouraged to have a minimally invasive procedure performed laparoscopically, with a few small incisions in the abdomen, or vaginally.

But surgeons are performing a growing number of minimally invasive hysterectomies – 176,000 in 2012  –  with a robotic system.

Although many hospitals are investing in high-tech robotic systems, the American Congress of Obstetricians and Gynecologists says the robot-assisted procedures should not be women’s first choice – or even their second – when it comes to routine hysterectomies. The ACOG cited a recent study that showed the robot system could actually lead to more complications than the other methods unless the doctor has performed many surgeries using the technology.

The Hastings Center, a nonpartisan research organization that focuses on bioethics and the public interest, has long studied health care costs and their impact. It has found that “new or increased use of medical technology contributes 40 to 50 percent to annual cost increases, and controlling this technology is the most important factor in reducing them.”

Technology plays an important role in modern medicine, enabling breakthroughs once hardly imagined. For women who are not good candidates for vaginal or laparoscopic procedures, use of the robotic system could well be the best alternative to the highly invasive open procedure. Indeed, MultiCare Health Systems has been able to reduce the rate of open hysterectomies to less than 10 percent due to its use of robotic technology.

But women should know all their options. If they’re good candidates for the least invasive, least expensive procedure, they should be made aware of that. High-tech procedures that don’t deliver better outcomes yet cost more should not be the default position as the nation struggles with debilitating health bills.

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