Practice Guidelines: Role of Economics and Physicians

It has been estimated that perhaps onefourth to one-third of U.S. health care dollars buy care that has only marginal benefit, if any. To lower this figure, some medical professionals have placed their hope in the increasing use of practice guidelines, in conjunction with other efforts aimed at fostering greater efficiency in the American health care system. This interest has come about despite the challenge that practice guidelines pose to the traditional autonomy that physicians have enjoyed in determining what procedures are medically necessary or effective, and that patients have had in receiving whatever treatment they desire. Guideline proponents argue that while the lessening of physician and patient autonomy might be regrettable, the larger good of providing at least basic health care to more people is the greater consideration. Of eight organizations participating in a survey on practice guidelines, all indicated that they developed guidelines primarily to improve “clinical effectiveness” and “quality of care,” but six stated that cost control was a secondary goal. Studies show that in some circumstances the adoption of guidelines can indeed lead to cost savings. For example, the institution of guidelines at the Yale-New Haven Hospital reduced the number of emergency room x-rays by 15 percent without compromising quality of care. Most proponents of practice guidelines, particularly in Congress, have argued that reducing costs might be a byproduct of the adoption of guidelines based upon medical effectiveness (through the elimination of unnecessary or marginally beneficial diagnostic procedures and treatments). To date, financial factors typically have not been incorporated explicitly into practice guide