When looking at the government's role in physician practice guidelines as they relate to
cost efficiency I think it is clear that there is a role for the government to play. Healthcare
is not a traditional free market where market forces can manipulate the environment to
drive down costs and increase quality. This is largely due to the heavily regulated nature
of the market, which keeps many key market forces in check. With this in mind, I can see
that government can be a useful tool in helping to drive cost efficiency.
Clinical practice guidelines are “systematically developed statements to assist
practitioner and patient decisions about appropriate health care for specific clinical
circumstances.” (Clinical Practice Guidelines, n.d.) The guidelines “define the role of
specific diagnostic and treatment modalities in the diagnosis and management of patients.”
(Clinical Practice Guidelines, n.d.) While the use of these guidelines is encouraged as
part of best practices, they are not “fixed protocols that must be followed, but are intended
for health care professionals and providers to consider.” (Clinical Practice Guidelines,
n.d.)
These guidelines provide potential benefits when looking at cost. a The most
obvious benefit for patients as well as the “greatest benefit that could be achieved by
guidelines is to improve health outcomes.” (Woolf et al., 1999)
These guidelines “promote interventions of proven benefit and discourage
ineffective ones have the potential to reduce morbidity and mortality and improve quality
of life.” (Woolf et al., 1999) They can also improve the consistency of the care that
patients receive. In fact, in multiple studies around the world, it has been shown that “the
frequency with which procedures are performed varies dramatically among doctors,
specialties, and geographical regions, even after case-mix is controlled for.” (Woolf et
al., 1999) Additionally, “Patients with identical clinical problems receive different care
depending on their clinician, hospital, or location. Guidelines offer a remedy, making it
more likely that patients will be cared for in the same manner regardless of where or by
whom they are treated.” (Woolf et al., 1999)
How does this influence the cost? The largest benefit with regards to cost
efficiency is that these clinical guidelines help to drive efficiency through standardization
of care of optimizing the value of money spent on healthcare. The implementation of
certain guidelines “reduces outlays for hospitalization, prescription drugs, surgery, and
other procedures.” (Woolf et al., 1999)
The publicizing of adherence to these guidelines can also lead to increased revenue
for many health providers through the improvement of their public image. By advertising
their commitment to these guidelines, they can tell potential patients that they are
committed to a better outcome for the patient. This messaging can help to “promote
goodwill, political support, and (in some healthcare systems) revenue.”
After reading through many articles concerning these kinds of guidelines I believe
that the government has an important role in keeping the focus of health care on the
patient and looking for means to create win-win scenarios where the providers gain
efficiency and therefore increased revenue that can be used to further drive efficiency in
healthcare. This creates a mutually beneficial continuous improvement loop that drives
better outcomes for all.
References
Clinical Practice Guidelines. (n.d.). NCCIH.
https://www.nccih.nih.gov/health/providers/clinicalpractice
Woolf, S. H., Grol, R., Hutchinson, A., Eccles, M., & Grimshaw, J. (1999, February 20).
Clinical guidelines: potential benefits, limitations, and harms of clinical
guidelines. The National Center for Biotechnology Information.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1114973/
