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High-Value, Cost-Conscious Health Care FREE

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The full report is titled “High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions.” It is in the 1 February 2011 issue of Annals of Internal Medicine (volume 154, pages 174-180). The authors are D.K. Owens, A. Qaseem, R. Chou, and P. Shekelle, for the Clinical Guidelines Committee of the American College of Physicians.

Ann Intern Med. 2011;154(3):I-30. doi:10.7326/0003-4819-154-3-201102010-00001
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Who developed these recommendations?

The American College of Physicians (ACP) developed this advice. Members of ACP are internists, specialists in the care of adults.

What is the problem and what is known about it so far?

Health care costs in the United States are high and getting higher. If nothing is done, less money will be available for other important things, such as housing, transportation, food, and schools. Americans must decide what things they will and will not spend money on in health care. The ACP thinks that focusing on the value of tests and treatments will help to control health care costs while ensuring that all Americans receive excellent care.

What does “high value” mean in the context of tests and treatments?

“High value” means that a test or treatment has benefits that make its harms and costs worthwhile. “Value” is not the same as “inexpensive.” Some expensive tests and treatments have high value because they provide high benefit and low harm. Some inexpensive tests or treatments have low value because they do not provide enough benefit to justify even their low costs and may even be harmful.

How can we estimate the value of tests and treatments?

First, the benefits, harms, and costs of a test or treatment are considered. Benefits include improvements in health or quality of life. Harms include adverse effects, unnecessary care, or care that ultimately hurts the patient. Second, costs include the cost of the test or treatment itself plus costs from any unwanted events caused by the test or treatment. Third, cost-effectiveness analysis evaluates the value of different tests or treatments by comparing the benefits, harms, and costs of one type of health care with others. Comparative effectiveness research is research that can help patients, providers, and policymakers compare the benefits and harms of different types of care.

Why are so many low-value tests and treatments used in the United States?

Many patients assume that better care means more tests and treatments and may be dissatisfied when a doctor does not use a test or treatment that the patient has heard about. Often, ordering tests or treatments is easier for doctors than explaining why they are not using them. More tests and treatments usually means more money for such entities as the company that makes the test or treatment or for a doctor or hospital that uses the test or treatment. Therefore, advertising and other marketing tools are designed to make people want more tests and treatments. Doctors also worry about lawsuits if they do not do what patients expect.

What does ACP recommend that patients and doctors do?

Doctors and patients should consider the value of tests and treatments and choose high-value options. Avoiding tests and treatments that provide little or no value will improve care and avoid harms to patients and needless costs. Doctors should use a patient's history and physical examination to determine whether the value of a test or treatment is likely to be high. When considering the value of a test or treatment, patients and doctors should consider not only the benefits and price but also the adverse effects and other unwanted events that may happen.





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