window.dataLayer = window.dataLayer || []; function gtag(){dataLayer.push(arguments);} gtag('js', new Date()); gtag('config', 'UA-97641742-42');

LMS President’s Message: June 2023

LMS President’s Message: What Economics Can Teach Us About Healthcare
By Lee Dossett, MD

I was an economics minor in college, and I still find the field of study interesting.  There is a concept I learned called the tragedy of the commons that I still often think about.  The tragedy of the commons highlights the dilemma that arises when individuals act in their own self-interest, depleting a shared resource and ultimately leading to its degradation or even collapse. Think of a group of herdsmen grazing cattle on shared land.  Each herdsman has the incentive to add cattle, but if they all act in their own self-interest and add animals, eventually the land will no longer be able to support them.  Typically, you hear about this today when talking about climate change.  However, this concept is increasingly relevant in healthcare as we grapple with the challenges of resource allocation and ensuring optimal care for all. 

In the realm of healthcare, the “commons” can be seen as the collective resources we rely on to provide quality care to our patients. These resources include hospital beds, medical equipment, healthcare professionals, and even financial support. With the rising demand for healthcare services and the limitations imposed by finite resources, it becomes crucial to strike a balance between individual needs and the greater good of the community.  The latest estimates suggest that on its current resources and spending, that Medicare will run out of money by 2031.  Congress would (hopefully) act to avert crisis well before then, but it should be instructive to physicians that we are operating in a system with finite resources.

Value-based care is a concept that aims to address this challenge. It focuses on delivering high-quality care that maximizes outcomes while minimizing costs. By shifting the focus from volume to value, the goal is to optimize resource allocation and ensure that healthcare resources are utilized efficiently and effectively.  As physicians, we play a vital role in advocating for the judicious use of healthcare resources. We must strive to provide evidence-based care, critically evaluate the necessity of interventions, and engage in shared decision-making with our patients. By practicing responsible stewardship of resources, we can contribute to the sustainability of our healthcare system while maintaining the highest standards of patient care.

I recommend all physicians visit ChoosingWisely.Org to learn about an effort to educate physicians about value based care.  This organization has worked with over 80 medical societies to develop the top recommendations to prevent overuse and unnecessary testing.  For example, my professional organization is the Society of Hospital Medicine.  Their top recommendations include things like not performing daily lab testing on stable patients and removing telemetry monitoring if there is no specific indication.  If you have further interest in this topic, “Understanding Value Based Healthcare” by Moriates, Arora, and Shah is essential reading on the subject.  It is slightly outdated with the first edition coming out in 2015, but most of the book remains quite relevant today.

I’ll leave you with a quote from the man who developed the tragedy of the commons concept.  Garrett Hardin writes, “Ruin is the destination toward which all men rush, each pursuing his own best interest in a society that that believes in the freedom of the commons.”  I encourage all of you to reflect on this issue and consider how we can individually and collectively contribute to the advancement of value-based care in our community. Together, we can make a difference and create a healthcare system that not only provides excellent care to our patients but also preserves and optimizes our shared resources for generations to come.