Study Blames High Prices, Technology for U.S. Health Care Costs

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In a per-capita comparison among a dozen other Western nations, the United States is far and away the price leader in healthcare if not the utilization leader, according to a new report from policy group The Commonwealth Fund. The report, which sources its data from the Organization for Economic Cooperation and Development claims that “average diagnostic imaging fees ($1,080 for an MRI and $510 for a CT exam) are far higher than what is charged in almost all of the other countries,” making imaging again a likely target for cost controlling. “This combination of pervasive medical technology and high prices showcases two potent drivers of U.S. health spending, and a possible explanation for the outsized share of resources we dedicate to health care relative to the rest of the world,” wrote Commonwealth Fund researcher David Squires. “I think the value of these sorts of national comparisons is to put what we do in perspective to other countries,” Squires tells Imagingbiz. “That’s not to say that we do more than we should or they do less than they should. It’s more about highlighting differences to explain some of the cost drivers.” The study compared per capita spending, not total spending, and costs as a share of GDP, Squires says. “Obviously in total terms, the U.S. spends many times more than do other countries,” he says, although he says his analysis excludes countries like Russia, India, and China, which are larger in terms of population, because he didn’t have good data. According to Squires, the United States “seems to be an outlier” in terms of technology usage. Although Japan has more CT and MR scanners installed than does America, he says that his study “doesn’t have information on whether people aren’t getting the imaging they need, or if they’re getting more than they need. The issue is what it costs. “It’s partially that we’re paying more for the same thing,” he says. “On top of that, we use more expensive medical technology. In terms of quality, it doesn’t seem like we are getting notably superior results.” Squires points out, for example, that although survival rates are highest in the United States for diseases like breast cancer and colorectal cancer, both of which rely on imaging studies as a component of care, “we’re below-average for cervical cancer.” “The study is about overall health spending, not about imaging in particular,” Squires says, adding that its main finding is that “on a system level, we are putting more in than any other country, and we don’t really go to the doctor or the hospital more [than do citizens of other countries].” Squires posits that the United States could find its way towards greater cost containment and performance improvement measures with the aid of stronger regulatory oversight and the support of best-practices initiatives like Choosing Wisely. “Choosing Wisely seems to me like a very positive development in terms of providers getting together and finding ways to cut back on what might not be doing patients any good, but I think there’s going to be a variety of tools that are going to have to be used,” he says.