The Discouraging Way Doctors Are Just Like Their Patients

Maybe, just maybe, the secret to saving money in the U.S. health-care system is to give patients more information.

At least, that’s the hope in certain corners of the health-policy world. Armed with more knowledge about nutrition, the thinking goes, Americans might choose broccoli over burritos. For surgeries, everyone from the government to insurers is releasing cost-comparison tools so that patients can browse procedures much like they would used cars—even though some studies suggest that these tools don’t actually save any money.

A new working paper challenges the notion that better-informed patients make better decisions. It found that an especially well-informed group of patients—physicians—don’t always make the best choices when they are patients, either.

For the study, which is out this week from the National Bureau of Economic Research and is still being peer-reviewed, three economists—Michael Frakes of Duke, Anupam Jena of Harvard, and Jonathan Gruber of MIT—used the military’s health system to compare everyday patients with patients who are themselves physicians. (The military system is one of the few databases that disclose a patient’s profession, Frakes told me.)

The study authors looked at several types of treatments in which people elect to get too much medical care, against scientific evidence—albeit sometimes under the guidance of their physician. They also examined situations in which people don’t get enough medical care, even when their health conditions necessitate it.

First, they considered C-section rates, which the World Health Organization recommends should be done at about half the rate they’re currently performed in North America. Among the pregnant female physicians, 29 percent got C-sections, compared with 31 percent of other pregnant female patients. But the pregnant doctors still didn’t meet the WHO guidelines, which suggest that only 10 to 15 percent of women should have C-sections. In other words, on C-sections, the doctors did appear to make more scientifically approved medical decisions, but not by much.

These findings, if strengthened by further research, would put a damper on the idea that the U.S. can resolve inefficiencies in its health-care system by simply giving patients more information. For example, the concept behind high-deductible health plans—in which patients pay higher costs before insurance kicks in—is that patients will research the prices of different procedures and avoid unnecessary care. But in this study, even the best-informed patients didn’t always do that.

True, online tools such as Amazon have made comparison shoppers of us all. But getting medical care isn’t like buying a toaster. It’s personal and often scary. You might ignore certain advice, or you might know, intellectually, that a test or procedure is unnecessary. But when it’s your own body on the line, the medical guidelines might not mean much.

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