A Medical Device Daily

The Government Accountability Office (GA) convened a gathering earlier this year to collect opinions from experts and opinion leaders on a variety of healthcare issues, ranging from direct-to-consumer (DTC) advertising to the country’s gaps in health insurance.

Leonard Schaeffer, a senior adviser to TPG Capital (Fort Worth, Texas), tackled the DTC topic and found lacking the major claim for it: that such ads help consumers make better healthcare product choices.

He said that advertising triggers preferences for specific medical technologies without offering information which helps to better evaluate a new drug or device, let alone its safety or relative efficacy.

“American consumers don’t have enough information in the healthcare market as opposed to other markets,” he said, adding that expecting people in this state of affairs “to behave as good consumers is not rational.”

However, Schaeffer noted that advocacy of rational healthcare policy by elected officials constitutes a third rail, because there is no agreement on the meaning of “rational policy.” He also said that even when consumers have price information, they do not make comparisons.

“If consumers don’t shop when it’s entirely their healthcare dollar, why would they do it with other payers’ money?”

Regarding one clear shift in the doctor-patient relationship created by DTC advertising, Schaeffer gave the example of ads for treatments for restless leg syndrome that lead consumers to “self diagnose and then go see their doctor. Healthcare technology diffuses on the five o’clock news,” with news features that highlight new products that patients and physicians cannot readily evaluate.

According to the GAO report, the group concluded that healthcare information technology (HIT) “is not a magic bullet to improve healthcare quality,” but can encourage “doing the right thing [as] the easy thing to do.” Still, some doctors see the quality standards that HIT will deliver as so much “background noise.”

As for financing HIT, the participants entertained the concept that investment in HIT “may be more likely when cost savings accrue to the entity making the investment.”

Comptroller General David Walker, the head of GAO, is said to have told the gathering that the U.S. government is on a “burning platform,” a description of the long-term fiscal exposure of more than $50 trillion related to Medicare and other spending, a sum four times last year’s gross domestic product.

Among the comments heard at the gathering was that the systems in the U.S. do not make meaningfully different use of technology or capacity compared to those of other Western nations, though the numbers of doctors and hospital beds per capita are about the same.

The real problem, one participant said, is the “provider oligopolies,” such as specialty hospitals that can self-refer, and the “unsavory relationships between physicians and drug companies and between physicians and the research community,” relationships suggestive of the military-industrial complex that President Eisenhower warned the American public to be on guard against.

The participants described the uninsured as “a very heterogeneous group” that is somewhat more likely to be unemployed than the insured, but who are not inclined to purchase insurance even when employed in reasonably remunerated occupations “because the cost is high, relative to the benefits they expect to receive.”

“From a policy standpoint,” the report says, “one of the most controversial sub-populations is the ‘tweeners,’” a group with incomes more than 150% of the poverty level but below median income, which is 325%-350% of the poverty level.

According to GAO, 75% of tweeners are insured, mostly through private insurance, but the remainder makes up half of the uninsured. One of the concerns for policymakers regarding this group is that public programs may crowd out private insurance programs that many members of this group could afford.

The consensus regarding tweeners is that because little evidence exists that a correlation between lack of insurance and health status translates into a causal relationship, catastrophic coverage for members of this group would likely yield an important benefit. But anything more generous would not necessarily yield meaningful gains in health.

Informal polls taken at the session suggest that consensus is building on a number of the larger questions, but as always, details matter.

The field was split almost down the middle on whether employer-sponsored coverage should remain the primary mechanism for insurance, but responses tilted strongly toward the affirmative on whether the federal government should take steps to ensure universal coverage, a notion that provoked strong agreement on the parts of 73 and agreement by another 23. Three participants had no opinion, and none were in disagreement.

DTC advertising did not fare well at the session.

Of the 101 participants, 52 strongly agreed that DTC ads should be limited, a notion that another 26 agreed with. Thirteen had no opinion, 10 disagreed, and none strongly disagreed.

Of the participants, 48 strongly agreed that Uncle Sam should provide incentives for adoption of HIT, and another 32 agreed. Ten had no opinion on the question and the remaining 10 either agreed or disagreed.