Savings are in the balance in hard choices in health care

A new study may signal our readiness–and reluctance–to rein in health care spending.

Cutting health care costs is a laudable goal, but where do we start?

Many analysts say it’s time to curb spending on so-called “futile” care for patients at the end of life. To explore that issue, University of Pennsylvania professor Scott Halpern and colleagues surveyed doctors and nurses who treat critically ill patients.

“Many physicians and nurses are not ready to limit care to the dying, and it strikes me as probable that many members of the public would not want their physicians and nurses to be limiting care to the dying,” said Halpern, deputy director of the Center for Health Incentives at the University of Pennsylvania.

The study asked health workers if they would give their last ICU bed to a dying cancer patient, or a brain dead patient whose organs could go to many other waiting patients.

About 40 percent of the surveyed doctors said they’d give the bed to the cancer patient.

“Even if there are substantial societal benefits to limiting the care they provide to individual patients, in the name of reduced costs or increase organs for transplantation, many people who work in the front lines in ICUs aren’t ready to make those trade offs, Halpern said.

Co-author Peter Ubel says doctors are trained to consider, and help, the patient in the bed before them. Physicians don’t get good training in weighing cost of their decisions for the faceless, anonymous patients “waiting in the wings.”

He says the health system needs balance.

“We can’t do everything for everybody. We have to think about how to spend smart, how to set good priorities that give us what we most want out of health care without bankrupting our country,” he said.

Ubel studies how people make health and health care decisions, and says paying doctors differently could nudge them to make different treatment decisions.

He says much of U.S. health care spending begins with doctors writing prescriptions and ordering “referrals, tests and procedures.”

Ubel says: Consider the patient who comes in after two weeks with shoulder pain. Should the doctor order an MRI or not?

If a physician is only thinking about the patient before her, and if that patient has good insurance, Ubel says a doctor is likely to order the scan.

The entire health system pays for that $2,000 test, he said.

“If you can wait a couple of weeks, see if the shoulder gets better, then may be that’s better for society and it really wouldn’t hurt the patient very much,” Ubel said.

The study appears in the online edition of the journal Intensive Care Medicine.