Patient involvement is necessary to rein in health care costs

LETTER — Posted April 15, 2013

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Regarding “Internists call to end 'assault' on doctor-patient relationship” (Article, March 1): The attention of the American College of Physicians to the erosion of the doctor-patient relationship is exactly on target. The most potent assaults on this relationship are the risk-sharing models of health care reimbursement (accountable care and bundled care) that are so rapidly sweeping through the country.

A physician who is incentivized to reduce health care costs, and profits from doing so, cannot have only the patient's best interest in mind when entering an exam room. Motivated by a bigger bonus, or fear of being terminated for overspending, doctors inevitably will insert cost concerns into their clinical decision-making. Patients will catch on that the providers are benefiting by providing less care, and the death knell of the doctor-patient relationship will be realized.

Cost of care certainly needs to be part of the decision-making, but not without engaging the patient. A balanced approach to this discussion will have impact only if the patient has some “skin in the game.” Involving patients in this way will help reduce costs, encourage patients to be more aware of their health care needs and even incentivize them to make better lifestyle choices.

For the sake of cost control, the doctor-patient relationship and quality of care, the discussion on health care reform needs to move in this direction.

Kenneth D. Croen, MD, Harrison, N.Y.

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