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Tuesday, March 29, 2005

Global market for drugs and healthcare needed

While there was widespread criticism of Merck, Pfizer, and other pharmaceutical firms for direct-to-consumer advertising, it seems that many other institutions see advertising as a way to increase revenues. It seems that if we have to make healthcare an attractive sector to invest, a lot more ethics have to be poured in. (Related article: Advertising strategy for prescription drugs)

In a study published by Robin Larson, Lisa Schwartz, Steve Woloshin, and Gilbert Welch, the authors write, "Many academic medical centers have increased their use of advertising to attract patients. While the content of direct-to-consumer pharmaceutical advertisements (ads) has been studied, to our knowledge, advertising by academic medical centers has not." I often see ads in newspapers for local hospitals along with those for cosmetic surgeons, spas, and beauty salons. Most consumers have a hard time thinking of a hospital the same way they think of a beauty salon no matter how attractive the hospital is and how great the doctors are. In a country in which we already consume more prescription medicines than we should and have over 35 million Americans without any health insurance at all, it is sickening to see that hospitals shamelessly target the wealthy positioning hospitals as some kind of "destinations." "Advertising to attract patients is common among top academic medical centers but is not subjected to the oversight standard for clinical research. Many of the ads seemed to place the interests of the medical center before the interests of the patients," the authors write.

It gets worse. The doctors too have joined the game of unethical business practices of healthcare plan providers. In another research paper, Wendy Levinson, Audiey Kao, Alma Kuby, and Ronald Thisted, find that many physicians receive financial incentives to limit their ordering of expensive tests and procedures. "While Medicare mandates disclosure of incentives, it is not clear how to inform patients without undermining trust," they write. So when my doctor is saying that I am just fine and I don't need those tests, he is not only risking my health and life, he is basically getting rich by doing so. May be I should fly once a month to Mexico for consultation with a doctor. (Related article: India emerges as a healthcare destination for Americans)

No wonder then that the American Association of Plastic Surgeons has found the same result in a different study. According to their research, "Increasing insurance company denials, restrictions on covered procedures and a new tactic of excluding specific procedures may be forcing some adults and children to live with painful medical conditions or disfigurement." This restrictive access to care contributed to a 10 percent decline in reconstructive plastic surgery procedures in 2004, according to the latest statistics. The 5.6 million reconstructive procedures performed in 2004 include a host of procedures that are restorative in nature and often reduce pain. Mind you, they are not talking about face lifts or Botox treatments that are considered as elective procedures. They are talking about procedures that are medically necessary.

"This new data is concerning because we don't believe there are less reconstructive procedures that need to be performed," says Scott Spear, ASPS president. "We are not positive, but we have some concern the insurance market is suppressing the ability of patients to get needed reconstructive plastic surgery procedures. Going forward, we want to make sure that reconstructive surgery continues to be covered by insurance."

Historically, when insurance companies have denied coverage, it was based on a lack of medical necessity; however, patients could appeal the denial and with proper scientific literature and evidence-based studies the denial could be overturned. The new exclusion tactic simply eliminates coverage of specific procedures due to contractual (insurance plan) language with no opportunity to appeal.

May be we need a global market for drugs and healthcare services sooner than we initially thought.

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American Association of Plastic Surgeons