What does the debate over mammography screening teach us about the challenges in moving to evidence-based medicine in a revamped health system?
The debate truly highlights how much work is yet to be done to build a health-delivery system that generates enough accurate dataso that we can truly 'know' the evidence! More importantly, however, it underscores two fundamental issues impacting broader health care reform:
1.The USPSTF made a recommendation for an 'overall population' vs. an 'individual' choice for a doctor and patient. The funny thing about statistics is that they're about percentage risks for a population, but individuals have different genetic profiles/risks, and attitudes and priorities around health. There is no one right answer for everyone. If the health sector were more market-orientedlike other industries (people have different 401k investment plans, different savings rates and the like) and not driven by health insurance companies or the government making determinations about what is 'right', consumerswould explore the information available and make their own choices with their physicians.
2.Insurance should address catastrophic events, not every day expenses. Yet people expect insurance to cover every doctor's visit, test and treatment, which is economically inefficient and establishes the wrong incentives for providers and consumers. People should pay for routine care -- doctor's visits, mammograms, routine medicines -- and only tap into health insurance when they need to cover major, unpredictable issues. If people were in charge of paying themselves, they would be more engaged in their health and understand how their choices impact themselves and others. Differentiating major medical coverage from full health coverage would reduce the incentive for some to over-consume health resources. This would enable more innovation in insurance and health delivery and make health care more affordable for all.
Evidence-based medicine is the 'brass ring' for health-care reform. Medicine is going to continue to evolve and improve, and we need the right system in place to ensure that individuals have the information they need to make informed choices about their care to drive the best outcomes for their health.