DIAGNOSTIC TESTS, SPECIALIZED PHYSICIANS, COMPLEX RELATIONS CONTRIBUTE TO HIGHER COSTS

Many changes have occurred during the thirty-seven years I have practiced medicine. Technological advancements have spawned new techniques and procedures. More diagnostic tests are available, physicians are more specialized, and the doctor-patient relationship has become more complex, resulting in increased malpractice suits. These changes are major contributors to the higher cost of health care.

The price of litigation

Up to 35 percent of the cost of health care goes to protecting the physician against malpractice suits. When I first started practicing, my malpractice insurance was $150 per year. Today it is $26,000 per year. Doctors spend an average of four years in medical school and five years in residency. They are trained as diagnosticians, yet the threat of malpractice suits will often cause them to order expensive tests that are not strictly necessary.

These costs could be reduced if doctors were given more freedom to exercise their professional judgment. 85 percent of all malpractice suits are ruled in favor of doctors, but even favorable cases cost the doctors between seven and ten thousand dollars.

The cost of settlements to avoid litigation is still on the increase in medical practice. Even when the court rules in the patient's favor, attorneys get as much as 50 percent of the settlement.

English method

One way to lighten the burden on the system would be to reduce or eliminate contingency fees. But, in my opinion, the most important action that can be taken to reduce the cost of malpractice suits is tort reform. We should consider using the English method, under which the plaintiff must pay all costs if he loses, including the costs of the defendant.

Another important problem is the high cost of health insurance. This cost is now so high that many small businesses cannot afford to provide health insurance for their employees. Insurance companies may be taking greater profits than they claim, and we need to look more closely at the way they determine the cost of insurance policies. State-mandated guidelines have prevented insurance companies from developing more basic and less expensive insurance policies.

Uniform insurance forms

The cost of insurance could also be reduced if there were uniform insurance forms one form for all insurance companies.

The problem of reducing health care costs is not simple. There are many aspects of our health care system which need attention, and we cannot treat any one in isolation from the others.

If Medicare and Medicaid ~do not pay the real cost of a patient's health care, hospitals have to shift costs to patients with insurance and those who can afford to pay so that they can stay in business. If patients do not have a living will, doctors cannot determine their wishes and may have to use expensive life-support technology to sustain their lives only a few days more.

Of Medicare dollars, 25 percent are spent in the last week of life and 10 percent on the last day. Medical technology provides new and more expensive life-saving procedures. Though no physician or hospital would like to deny these procedures to anyone, the system might not be able to afford granting equal access.

Cooperation required

Reducing costs of health care will require the cooperation of all parties involved. Health care consumers may have to learn to expect less. State legislators need to rewrite health insurance regulations. Attorneys should reexamine a malpractice system that seems to be out of control. Medical professionals should try to control fees and other costs.

All Americans need to think carefully about the right to health care and their own personal responsibility for individual health care.

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Mel C. Kasten, M.D., is Chairman of the Council of the Missouri State Medical Association.