One of our mantras here at IB is that health care costs drive health insurance costs, which is one reason why we espouse transparency and accountability, and frown upon benefit mandates. We look at utilization as one measure of health care cost; that is, how often, and under what circumstances, a given procedure is used.
The prototypical example of this is hysterectomies: back in the day, there was quite a controversy regarding elective versions of this procedure. Part of the problem was that it was a fairly simple yet lucrative process, and so held great appeal to a certain segment of the physician community.
More recently, we learn that carriers are cracking down on what they perceive to be a similar burgeoning case of over-utilization: medical scanning technology. This would include PET and MRI scans, for example, as well as CT and even x-rays. The tech for these has dropped in cost, and as a result, we have a lot of these machines that need to be paid for. I understand, for example, that we have more MRI machines here in Ohio than in all of Canada. Is that necessarily a bad thing? Of course not, but then one must ask: "who pays for this tech?"
The answer, of course, is that we all do.
But that may be changing:
"Insurance companies are taking a harder look at advanced medical scans like CT scans, citing spiraling costs and safety concerns. And some doctors agree there’s emerging evidence that these scans are being over-prescribed."
Buying, maintaining and operating all this equipment isn't free, and the cost is reflected, in part, in increased insurance premiums (see, health care costs more, thus health insurance does, too). In order to rein in some of these costs, insurers are starting to take a closer look at whether they're justified, and justifiable.
Folks who've bought into Consumer Driven Health Care (CDHC) already know this: it's their own money that pays for MRI's instead of x-rays, for example. So it's no real surprise that carriers have begun to second-guess their use, as well.
And there's this:
"Insurers fear some patients are being exposed to dangerous radiation levels from having repeated CT and PET scans, which use many times the radiation of a regular chest X-ray...Doctors, too, are concerned about patients getting excessive radiation exposure when they receive scans that aren’t needed or are ordered as “defensive medicine” to protect against possible lawsuits."
Not to mention the conflicts of interest when physicians also own the "imaging facilities" to which they refer their patients.
O Brave New World, indeed.
(Hat Tip to Holly Robinson)