title: Benefits foregone: too much of the wrong and too little of the right. Based on a presentation by Bernard S. Bloom, PhD.
abstract: Physicians, patients, and payers use some interventions that do not work, while they ignore others that have a scientific basis for efficacy. As a society, Americans are unwilling to address collectively healthcare issues, as witnessed by legislative inaction on reform. They have chosen instead to leave such matters up to the impersonal economic market. In doing so, the basic laws of economics must be taken into account: Healthcare resources are limited and conscious societal trade-offs must be made about who gets which services, how much, and who pays. Healthcare resources tend to be rationed according to income, even with Medicaid and other programs available to those with low incomes. The economic market lacks perfect or almost perfect information to enable rational choices to be made among alternatives. Even when the value of an intervention is known, physicians may over- or underuse it. Much of the literature focuses on overuse, but underuse is finally being recognized as a severe problem. For example, effective prevention and treatment measures for breast cancer exist and should be promoted for appropriate candidates, despite the low relative risk of adverse effects like other neoplasms.
mesh_terms: D001294:Attitude to Health; D001943:Breast Neoplasms / Q000191:economics / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D015276:Health Care Rationing; D019981:Health Care Sector; D006300:Health Services Misuse; D006801:Humans; D011320:Primary Health Care; D014481:United States