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How to Lower Healthcare Spending and Increase Health Equity

Jonisha Brown, MD

Disclosures

July 18, 2022

Healthcare in the United States is broken. There are multiple reasons for this breakdown, in particular, the high cost of healthcare spending. As providers, we often spend more time discussing how insurance overhead, health system mergers, and patient nonadherence contribute to this spending and less time contemplating the role we play in increasing healthcare cost.

What can we do within the clinical encounter to lower healthcare costs while staying true to the overall goal of health equity? Here, I pose two quick actions to simultaneously target costs and equity, and they are simpler than you may think.

Step 1: Believe Your Patients

I recently had a conversation with a colleague about how practicing nonevidence- based medicine leads to overspending within the healthcare system and I couldn't agree more. Most of us follow USPSTF guidelines to decide what preventive actions are appropriate for a given patient. The guidelines are very clear; however, there are times when we may wonder if sticking with the evidence is the right thing to do.

Consider this example: A 35-year-old nonsmoking woman who is not obese tells you that she has not been sexually active since her last annual physical. She reports having no medical issues but needs a pap smear, as her last one was about 4 years ago. So what do you order?

Answer: Her pap smear and maybe HIV testing (if she has not completed this testing, which is recommended at least once after the age of 15 years old).

This may seem clear to some but unfortunately, I have witnessed providers in similar scenarios choose to add additional STD testing to the pap smear sample. When asked why, they express concern that the patient could be lying or may not accurately remember the last time she was involved in sexual activity. Aside from the absolute travesty of assuming a patient is lying or that they don't have the capacity to remember personal details about their life, this can cause overspending through the ordering of unnecessary tests. It can also lead to inconclusive results that become even more of a strain for the healthcare system and the patient.

Instead of ordering the extra unwarranted test on the assumption of a patient's character and ability, consider saving money and improving your doctor-patient relationship by believing your patient and only order what is indicated by the patient report and evidence.

Step 2: Listen to Your Patients

Now this may seem rudimentary, but it is widely known that we as doctors are terrible listeners. Listening to your patient may lead to an earlier diagnosis of a medical disorder and an earlier diagnosis can decrease overall morbidity and mortality for many disease states. Specifically, for minority patients, an earlier diagnosis has the potential to narrow the disparity we see in many health outcomes.

Often health disparities are attributed to patient deficits such as financial instability, access to healthcare, or lifestyle choices. But we should also consider the role a provider plays in the creation of disparities when we fail to fully listen and address a patient's concerns during the healthcare visit. Addressing symptoms early, before they worsen to the point of needing acute interventions, could result in decreased emergency department utilization, saving the healthcare system and the individual patient time and money.

In the space between evidenced-based medicine and the continued fight for health equity in the United States, we find two golden rules: Believe your patient. Listen to your patient. Alone, these actions will not fix our broken system, but they are steps in the right direction to lower healthcare spending while also improving our relationships with patients.

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About Dr Jonisha Brown
Jonisha Brown is a faculty member in the Department of Family Medicine at Atrium Health. She earned her medical degree from Wake Forest University, Bowman Gray School of Medicine, and continued to complete her residency training in family medicine at Carolinas Medical Center where she also served as chief resident. Dr Brown obtained her BS in psychology and BA in biology from the University of North Carolina at Charlotte. She enjoys spending time with her husband and two boys, traveling, and experiencing cultures through food, conversation, and entertainment.

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