Physicians aren't the only ones who contribute to over-prescribing medications. Some patients are downright bullies. After watching the commercials, these patients tell/insist/demand their practitioner prescribe a particular medication. This is called presenting the solution before defining the problem. Maybe they too are taking lessons from our politicians, "I know I've got a bacterial infection go ahead and prescribe me the (wrong) antibiotics so we can nip it in the bud." Properly diagnosing an ailment isn't always a "one tripper" (single office visit). Sometimes you need to wait a few days, if the symptoms get worse you may need to go back to your practitioner. One trippers can result in over-prescribing or prescribing the wrong medication. Sometimes patients need to have patience with their practitioner.
Patients who are not forthright and honest with practitioners also hinder the ability to diagnose and treat them. Some patients feel embarrassed or guilty. Maybe health care providers ought to put a chapel in their offices so their patients could address their fear (pray) and guilt (confession) before their visit. After all, there are already chapels in airports and hospitals. Similarly some supermarkets have banks: that sort makes sense; get money before you go shopping.
Player: Health Care Practitioners
By definition health care practitioners include physicians, nurse practitioners, nurses, therapists, chiropractors etc. Practitioners have financial incentives to do more "stuff" (require more diagnostics, prescribe more medications, and perform more procedures). Further, many of the labs and imaging facilities are owned by the very practitioners that are prescribing and directing the patients to go there. Can you say conflict of interest? I knew you could. CPAs aren't allowed to own a single share of the stock of the company they are auditing.
Another reason practitioners over prescribe and perform more diagnosis than necessary is to avoid frivolous law suits. (Special thanks to our tort attorneys).
Here's the bottom line: Practitioners are trained in medicine and the associated risks. After conflicts of interest are removed, practitioners are in the best position to recommend diagnostic procedures and treatment for their patient, not the bean counters or insurance companies. Most practitioners really went into their respective field to heal people, not for the money.
Player: Insurance Companies
Insurance companies, like politicians where bureaucracy knows no bounds, are the best stall artists on the planet when it comes to paying. Consequently, practitioners must fund the additional working capital (cash flow) which translates into more non-medical costs (interest).
If that weren't enough, the practitioner must maintain a very specialized and expensive administrative staff to interface with insurance companies (verify coverage, bill, follow up on payments, follow up on payments, follow up on payments...)
Practitioners are also subject to audit by the insurance companies. In concept, audits aren't a bad idea. Where it goes sour, is when the insurance company hires auditors on contingency (The more 'waste’' they find the more they get ). Hello folks, again, can you say conflict of interest? As a retired CPA and public auditor, I'll point out that it is against the code of professional ethics to audit on contingency.
Player: Trial Attorneys
Strict liability standards have morphed into hot coffee liability in this country, and there appears to be no disincentives to discourage filing frivolous lawsuits. Liability insurance premiums have been increasing proportionally to health care costs, and the patient is the cash cow (coincidence? I think not...). It's not just the cost of the final judgment against health care professionals, it's also the legal cost to defend such lawsuits.
Additionally, some areas of medical specialty are so rife with lawsuits that fewer medical students are choosing that field. Case and point, Obstetrics: A study released in 2004 by the American College of Obstetricians and Gynecologists (ACOG ) disclosed:
• 1 in 7 have stopped delivering babies because of the fear of being sued.
• In 2004, only 65 percent of the OB/ Gyn residency slots were filled by U.S. medical school seniors, compared with 86 percent a decade earlier.
• The survey also found that 49.5 percent of all claims against OB/Gyns are dropped by plaintiffs' attorneys, dismissed or settled without payment – and that OB/Gyns win eight out of every 10 cases that go to court.