Column – American Health Care has a diagnostic issue


As everyone knows, America has one of the highest health care costs in the world, spending $4.1 trillion a year, or about $12,500 per person, three times the OECD average. But another aspect of our healthcare system receives far less attention: our focus on reactive treatment rather than proactive diagnosis and preventive care.

The truth is that our healthcare system is currently designed to treat existing conditions, rather than to minimize or prevent future health problems. People without insurance often rely on emergency services, which, by definition, deal with immediate health issues. However, even people with excellent insurance often find it much easier to get treatment than preventative care.

This is a problem, because the innovations that promise to have the greatest impact on health outcomes in the years to come largely focus on diagnostics or rely on early detection to turn serious or terminal diseases into manageable conditions. To get American health care back on track, we must focus not only on reducing costs and ensuring access to care, but also on changing the kinds of care that people have access to.

The economics of diagnosis

There are over 4,000 different tests on the market today that can detect diseases early, before they are life-threatening. From blood tests that detect cancerous DNA fragments to advanced imaging that detects Alzheimer’s disease at an early stage based on changes in brain volume and retinal scans that can reveal Parkinson’s disease, we now have a plethora of tools to improve health outcomes.

Unfortunately, systemic barriers are holding back the adoption of these new technologies. One is simple: insurers are driven by profit and there is little point in spending money now to prevent health problems a year or a decade from now. After all, with 55% of Americans are considering quitting their job, the patient may well have changed insurance companies by the time a health problem arises.

The result is that diagnostic care tends to be overlooked and underfunded. Once you spot a disease, you have to treat it – potentially at enormous cost over a period of years or decades. If you let a chronic illness go unnoticed until symptoms become evident, you may only have to pay for a few months of relatively inexpensive palliative care.

Sounds cynical, even shocking? Welcome to the American healthcare system. It took decades for insurers to cover mammograms after they were developed in the 1960s, and it wasn’t until legislatures issued mandates that women finally gained consistent access to this basic and very efficient.

Barriers to Availability

But diagnostic and preventive care are not only hampered by the self-interest of insurers. Physicians and physicians are often reluctant to widely deploy diagnostic tools that can be used effectively by non-medical professionals or even by patients themselves. While there are legitimate reasons to ensure that clinical decisions are made by properly trained and licensed professionals, this friction makes diagnostics more expensive and harder to access for many Americans.

Similarly, it can take years or even decades for regulators to approve new technologies, and the wait is getting longer. From 2008 to 2013, it took regulators an average of 83.1 months to approve new medical technologies. Between 2014 and 2018, this figure increased to 89.8 months.

Why are regulators taking so long to clear medical innovators to market their products? This is partly because they allow the perfect to become the enemy of the good. A new diagnostic intervention could offer a clear pathway to spot diseases early and save lives, but it will still have to go through years of additional data collection and research before it can gain regulatory approval.

This is frustrating, because diagnostic and preventive tools generally carry little risk. It makes sense that a surgical implant would come under scrutiny, for example, because if it goes wrong, people’s lives are in danger. A diagnostic measurement, on the other hand, is generally safer to use: the bigger question is whether it is accurate. This isn’t a trivial concern, but it shouldn’t become a barrier to adoption either.

What are the solutions ?

To make matters worse, we need to find ways to drive adoption of a new generation of diagnostic tests. This will require rethinking how we consider scientific evidence when determining which medical technologies to approve and deploy in our hospitals, labs and clinics.

Currently, regulators use “evidence-based” criteria to determine what to approve. This basically means that the treatments must be proven safe and effective, based on a comprehensive study. This is an important approach that is well suited to medical innovations where there is a significant theoretical risk to the patient. For example, before approving a systemic drug, we must be absolutely sure that it does not have serious side effects.

But it makes no sense to hold diagnostic and preventive measures that don’t have the potential to directly harm patients by the same standard. Instead, we must move towards a “evidence-based” approach; still rooted in scientific research, of course, but designed to give doctors and caregivers more leeway to use their own judgment on what’s in a patient’s best interest.

It follows that a new scan capable of detecting cancers while they are still treatable could take years to be approved under an evidence-based regime. To truly understand the benefit of early disease detection, test and control populations would need to be tracked, perhaps for decades. It may seem obvious to you or me that getting stage 1 lung cancer would be advantageous over stage 4, but proving this requires a better understanding of the effectiveness of early treatment versus late treatment, from what conditions people might otherwise have died if not from the lung. cancer and, if insurance coverage is desired, whether it is cost-effective for the health system.

An evidence-based approach, on the other hand, allows physicians to build on an understanding of the mechanism by which an intervention works, and then use common sense intuition about the benefits that might result for a patient. patient. Instead of waiting, they could act quickly to adopt such tools and start saving lives.

Patients first

The main priority of any healthcare system should be the well-being of patients. Right now, the US healthcare system is failing to target low-hanging fruits that could help deliver better patient outcomes and, by catching diseases earlier, ultimately lower the cost. of our health system.

Diagnosis and preventive medicine are an integral part of the health care process. It’s time to start working consciously to remove economic and regulatory barriers and to ensure that we are using new medical technologies effectively to optimize outcomes for our patients.


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