Second guessing physicians ≠ less expensive health care

Medpage Today has a report on Medicaid programs restricting DMARDs (disease-modifying anti-rheumatic drug) use for rheumatoid arthritis in an attempt to save money.  Long story short: it doesn’t.  An excerpt:

In addition, Dr. Fischer said, although prior authorization appeared to have a short-term effect in reducing the use of targeted drugs, the effect did not appear to last and spending rapidly returned to the same level as in other states. Furthermore, since there is some cost to states to implement these policies, it is not clear that they save money at all.

This will come as no surprise to anyone who has read Michael E. Porter and Elizabeth Olmsted Teisberg’s book Redefining Health Care.  An excerpt from page 47:

[T]hinking regarding cost reduction has been short run, relying on quick hits, such as eliminating expensive drugs or diagnostic procedures, rather than on more fundamental cost reduction over the full cycle of care.  True costs, and value, can only be measured over the full cycle of care, which begins with prevention and continues through recovery and longer-term management  of the condition to limit recurrence.

This is what happens when bureaucrats second guess doctors, or when an economic policymaker fails to think beyond stage one.

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