A candle flickers. Steam from a loaf of freshly baked bread entwines with the candle smoke like ballroom dancers. I look at the wine list. A loud thud echoes throughout the intimate dining establishment as my jaw hits the floor. One bottle of wine commands a price tag comparable to three times my salary from my first job after college.
I pondered if this expensive wine was truly that superior. I am not the first to ask this question: Numerous others have posed it. Blind taste tests with wine experts are arranged, and a humble wine often prevails over the expensive one (Bell, 2012). In the tests, tasters had used metrics such as cost, winemaker labels or let personal expectations or biases sway their judgement.
These metrics are not only used in assessing wine quality, but also the quality of medical care. The newer, more expensive or fancier the technique, the more effective an intervention must be! Right? But, like the expensive wine, this is not always the truth. Recently, Consumer Reports found that primary-care doctor groups can provide high quality care for a lower cost compared to other groups involved in the analysis (Consumer Reports, 2012).
With healthcare costs sky rocketing and becoming too expensive for many people (even for those with insurance), the topic of cost-conscious care is an imperative one. In an article pertaining to medical waste, newly minted doctors tend to embrace the newest technology, but this technology tends to be pricey (Knowledge@Wharton, 2016). Most of these very same doctors also don’t receive formal training in cost-conscious care. Fortunately, many (but not all) residency programs are incorporating programs pertaining to cost-conscious care (Knowledge@Wharton, 2016).
Aside from learned habits driving the overboard use of unnecessary tests and treatments, fear of litigation can be another driver (Knowledge@Wharton, 2016). While improvements in training or changes to litigation policies may change how doctors approach medicine, improving diagnostic tests or diagnostic protocols may be another alternative that can reduce cost without sacrificing quality. On paper, this sounds achievable through initiatives set forth by the precision medicine movement (Personalized Medicine Coalition, 2017).
Recently, a physical exam regimen highlighted in Sciencemag and offered by Health Nucleus appears to be taking the cost saving opportunities offered by precision medicine in the opposite direction. For a mere $25,000 (This is definitely more than my salary from my first job.), the company offers a medical exam that includes full body magnetic resonance imaging, highly detailed imagery of how well the heart moves blood, other tests that look at heart function, sequencing of the bacteria in the gut, analysis of the metabolites found in the body, genomic sequencing, tests for brain function, and more (Cross, 2017; Health Nucleus, 2017).
A description of the “experience” certainly makes one feel that they are receiving state-of-the-art medical care, but at a high cost. At this price, many insurance companies are not likely to rapidly adopt this type of care. A “bargain package” exists, but costs $7,500 (Cross, 2017). It is doubtful that even Cadillac insurance policies will cover this “bargain” testing.
These expensive diagnostic packages show promise in catching problems early (Perkins et al., 2017), but can researchers produce a diagnostic test that can yield just as comprehensive medical insights at a lower cost? If so, would doctors, patients, and insurance companies readily adopt cheaper, but highly effective tests? Would these lower-cost diagnostics be judged as equivalent or superior to more expensive options? These questions are tougher than deciding which wine to pair with my evening meal. Maybe a blinded assessment is in order?
Bell, K. K. (2012). Is There Really A Taste Difference Between Cheap and Expensive Wines? Forbes. Retrieved from https://www.forbes.com/sites/katiebell/2012/07/09/is-there-really-a-taste-difference-between-cheap-and-expensive-wines/#2c42b7253ae2
Cross, R. (2017, May 12) This $25,000 physical has found some ‘serious’ health problems.
Others say it has serious problems. Retrieved from http://www.sciencemag.org/news/2017/05/25000-physical-has-found-some-serious-health-problems-others-say-it-has-serious
Health Nucleus (2017, May) Retrieved from https://www.healthnucleus.com/clinical-tests-and-imaging.
Medical care cost vs. quality: You don’t have to pay the highest prices to get quality care.
Consumer Reports (2012, October). Retrieved from http://www.consumerreports.org/cro/magazine/2012/10/when-costlier-medical-care-isn-t-better/index.htm
Medical Waste: Why American Health Care Is So Expensive. Knowledge@Wharton (2016,
August 18). Retrieved from http://knowledge.wharton.upenn.edu/article/medical-waste-american-health-care-expensive/
Perkins, B. A., Caskey, C. T., Brar, P., Dec, E., Karow, D., Kahn, A., . . . Venter, J. C. (2017). Precision Medicine Screening Using Whole Genome Sequencing And Advanced Imaging To Identify Disease Risk In Adults. bioRxiv. doi:10.1101/133538
The Personalized Medicine Report 2017 Opportunity, Challenges, and the Future. Personalized
Medicine Coalition (2017). Retrieved from http://www.personalizedmedicinecoalition.org/Userfiles/PMC-Corporate/file/The-Personalized-Medicine-Report1.pdf