May 7, 2015

How Americans can get a better deal on health care

Dr. Diana Buist with Dr. Matt Handley, Group Health medical director for Quality and Informatics, and chair of the Washington state Choosing Wisely task force.

We’re smart shoppers—except when it comes to health care. Here are some ways to upgrade our care quality without paying more.

Recent reports show that the United States currently spends more per person on health care than any other developed country, yet health outcomes are among the worst. Why isn’t that extra money translating into better care? In part, because one-third of medical care doesn’t improve health and might cause harm. In contrast, we don’t spend enough on keeping people well. Only half of U.S. adults receive recommended preventive care that could stop serious medical problems from developing. Health researchers classify unwise treatments as overuse, misuse, or underuse. Health care shoppers who recognize these high-cost, low-value options can make smarter health care choices.

A classic example of overuse and misuse is getting a prescription for antibiotics to treat a common cold. Drugs like penicillins work only against bacteria. Colds and other common upper respiratory infections are almost always caused by viruses, which are not stopped by antibacterial antibiotics. Nationally, antibiotic prescriptions to treat colds are estimated to cost $1.1 billion annually. And the problem goes beyond unnecessary costs. Patients, schools and daycares who request antibacterial antibiotics for colds are endangering themselves, their families, and the community. Using these drugs when they aren’t needed leads to antibiotic-resistant bacteria that are hard to treat.

An example of underuse is inhaled steroids for chronic asthma. These medications reduce symptoms, emergency department visits, and hospitalizations. However, consumers are wary of inhaled steroids because of concerns about side effects such as osteoporosis, which is a worry with chronic oral steroid use, but rare with inhaled steroids. Making sure that people with asthma use a steroid inhaler when needed could make them significantly healthier.

As a health care consumer, my most satisfying experiences are when I talk with my physician about care options that have the best chance of working, based on current clinical guidelines. Sometimes this means more treatment, but often the best option is not the one that is the most aggressive, expensive, or invasive such as more images, medications, or tests.

As a health care researcher, I encourage people to be informed consumers. Becoming an active participant in your own health and care is just a click away, at the Own Your Health site. This resource, presented by the Washington Health Alliance, a nonprofit organization for health care consumers and payers in Washington State, has information about talking with your doctor, learning about a diagnosis, and making smart treatment choices. I’m involved in the Choosing Wisely® campaign, which you can find from the Own Your Health site. Choosing Wisely was started by physician groups and has plain-language health information developed by Consumer Reports.

We can all be better consumers of health care if we insist on value for our dollars. By learning about and demanding effective care for ourselves, we can also be potent agents of positive change for the U.S. health care system. And smarter national health care spending means more resources for growth, infrastructure, and economic development.


Diana Buist, PhD, MPH, is a senior investigator at Group Health Research Institute.