Cutting the Cost of Health Care: The Physician's Role

T he ever-increasing cost of health care is reason for every American to be concerned. In 2008, for example, healthcare expenditures in the United States reached $2.4 trillion, accounting for 16% of gross domestic product. By 2013, these expenditures had risen to almost $3 trillion annually, 17.4% of gross domestic product. Worse still is the amount of wasteful spending in health care. A study by PricewaterhouseCoopers’ Health Research Institute, published in 2010, calculated wasteful spending at up to $1.2 trillion, more than half of all spending on health. In 2012, Berwick and Hackbarth presented data that placed the lowest estimate of wasteful spending at 20% of all healthcare expenditures; however, they emphasized that the actual total might be far greater. During the past 40 years, various steps have been taken to control healthcare costs, including global budgeting, managed competition, cost-sharing, and pay for performance. Unfortunately, no effort of any sort has proved effective. There are many different causes of these exorbitant expenditures. Among them are an aging population; personal health habits such as smoking and improper diets that can lead to cancer, cardiovascular disease, and diabetes mellitus; the continuous development and use of expensive new drugs and procedures; and a reimbursement system that often rewards both inappropriate and appropriate uses of technology. I will mention other important causes in this editorial, but my main focus will be on the role that physicians play in creating this costly mess and on how we can help to fix it.