The depressing history of medical cost containment

As told by Steven Schroeder in a recent Archives of Internal Medicine article (h/t Brad Flansbaum):

During my professional lifetime I have witnessed a succession of individual cost containment strategies, each theoretically legitimate but each doomed to failure because they were either insufficient as a single intervention or ran up against political opposition to vigorous implementation.

Schroeder then runs through them. Near the end of the brief article, he contrasts the US and European models of care with the following anecdote:

During a 1982-1983 sabbatical in London, England, I visited a number of European teaching hospitals, meeting with medical staff and accompanying them on rounds. Patients on the medical wards were similar to those at US teaching hospitals. But when I visited the ICUs, it was different: the proportion of special care beds was smaller, and the patients were less sick. I was struck by the relative absence of the extremely ill patients seen so commonly at American teaching hospitals, typically supported for many of their vital functions and often with terminal illnesses. When I asked about this, there were embarrassed silences, and then someone who had spent time in the United States would explain the difference. “I loved being a fellow at X medical school. The facilities were state-ofthe- art, the teaching was superb, and the atmosphere was stimulating.” Then there would be a pause, and the physician would finally explain, “But you don’t know when to stop.” As I began to understand these cultural differences, it seemed that at every step along the referral chain the United States had more powerful forces pushing toward greater intensity of care.

Schroeder is a former president of the Robert Wood Johnson Foundation (fuller bio here).

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