Current health costs pushing docs to make urgent choices

(HealthDay)—The current growth in health care's share of the gross domestic product (GDP) and need to implement learning health systems is forcing physicians to make important choices, according to a perspective piece published online Dec. 12 in the New England Journal of Medicine.

Noting that physicians are accustomed to benefiting from health care's growing share of the GDP, Arnold Milstein, M.D., M.P.H., from the Stanford University School of Medicine in California, discusses the impact of closing the gap between health care spending and the GDP.

The author notes that the current annual gap of 2 to 3 percent between health spending growth and GDP has far-reaching economic consequences, with an increasing proportion of Americans requiring public funding to afford access to health care. New methods need to be adopted in health care, which are outlined in the Institute of Medicine's vision for a learning health system. To foster robust learning health systems, incentives are available for improving value, but these are likely to result in a decrease in the demand for physicians' services. Physicians can resist these policies which threaten their income. To protect their own incomes, they can lobby to slow policies limiting spending; additionally, they can enhance their incomes by exporting their expertise via telecommunication.

"The Congressional Budget Office's diverging trend lines present physicians with an urgent choice," the author writes. "One path leads to a gain of 2 to 3 percent in annual efficiency, robust federal creditworthiness, and thereby equitable access to good care, the other to better protection of physicians' incomes and traditional roles but wider informal rationing of health care services."