One of the biggest contributing factors to overpricing in the health care industry is the price and prevalence of prescription drugs. Prescription drug prices make up 10 percent of the U.S. health care costs and are, on average, 50 percent more expensive than in other developed nations. The “Bitter Pill” article from “Time” magazine referenced in my last column gave a few examples of the difference in prescription costs between nations: The price of one Lipitor pill in the U.S. is the same as three Lipitor pills in Argentina. One Plavix pill in the U.S. is the same as that of four in Spain, and one Nexium pill in the U.S. is the same as that of eight in France.
But the high price of prescription drugs is just the beginning of the story. When patients are prescribed drugs, they often fail to understand the effect that the prescription may have.
Consider someone with high blood pressure (called hypertension) who is prescribed beta blockers, which blunt the body’s response to the nerves responsible for increased cardiac action. A doctor may prescribe a beta blocker and recommend that an effective means of reducing blood pressure is to engage in regular, vigorous exercise. However, if this person wants to eventually work toward eliminating dependency on medication by exercising, he is going to run into an unforeseen problem: Beta blockers lower your maximal exercising heart rate and decrease your time to exhaustion, making vigorous exercise almost impossible. Basically, he is going to have a much tougher time getting healthy and reducing his dependency on medication primarily because of the medication itself. As a result, he’ll be much more likely to become shackled to the beta blocker prescription for the rest of his life in spite of a personal desire to accomplish a healthier routine through lifestyle modification. And just like that, doctors and prescription drug companies develop a lifelong customer.
Much like the hypertension prescription situation, it is fairly common for doctors to prescribe medicine that a patient doesn’t need. A 2008 study published in an issue of “Clinical Infectious Diseases” cited previous studies, which suggested that half of the estimated 100 million antibiotic prescriptions written per year were unnecessary. While doctors can often financially benefit from over-prescribing, the aforementioned study also said that more than 140,000 people (many of them young children) are rushed to the emergency room after a serious reaction to an antibiotic. Nearly 9,000 of those patients have to be hospitalized, and so begins another cycle of excessive over-pricing and unfair medical bills.
Moral of the story:
1. Americans need to lobby for change in health care costs. There is no need for the U.S. to be spending twice as much as other developed nations. Steven Brill estimated in his article “Bitter Pill” that cutting prescription drug costs could save the U.S. more than $94 billion.
2. Promote initiatives that work to change the culture of over-prescribing in health care. “Choosing Wisely” is an initiative by the American Board of Internal Medicine to get doctors and patients talking about unnecessary prescriptions and tests. Part of the initiative included a list of 45 treatments and tests that doctors should prescribe far less often or stop prescribing entirely. The initiative is currently being challenged by the Obama administration as an attempt to ration care, but is the first sign of serious reform. Educate yourself on the 45 treatments and become part of the movement to promote these types of initiatives.
3. Be an informed patient. A healthy diet and regular exercise are two key factors in reducing your trips to the doctor, but also understand the physiological effects medicine has on your body, especially common prescriptions such as those for antibiotics or beta blockers.
