NY Times Economix blog: CT Scans and Health Reform

David Leonhardt writes about growing evidence of overuse of CT scans and growing evidence of risk due to radiation exposure:

This week’s news about CT scans [Editor: link is to other NYT article] offered the latest evidence of the problem with fee-for-service medicine. Radiation from the CT scans done just in the year 2007 will eventually cause 15,000 extra deaths, researchers reported in The Archives of Internal Medicine. And scan use continues to rise, so the death toll will probably grow. An editorial accompanying the research paper suggested that there appeared to be “significant overuse” of such scans.

Many of those scans, of course, bring in extra revenue for doctors, hospitals, medical-device companies and the like. The scans are also also one small reason health costs are rising so rapidly and insurance has become unaffordable for so many people. CT scans are, in a nutshell, precisely what’s wrong with fee-for-service medicine: It causes wonderfully useful treatments and tests to become overused.

Here is more from the Internal Medicine editorial:

A popular current paradigm for health care presumes that more information, more testing, and more technology inevitably leads to better care. The studies by Berrington de González et al and Smith-Bindman et al counsel a reexamination of that paradigm for nuclear imaging. In addition, it is certain that a significant number of CT scans are not appropriate. A recent Government Accountability Office report on medical imaging, for example, found an 8-fold variation between states on expenditures for in-office medical imaging; given the lack of data indicating that patients do better in states with more imaging and given the highly profitable nature of diagnostic imaging, the wide variation suggests that there may be significant overuse in parts of the country. For example, a pilot study found that only 66% of nuclear scans were appropriate using American College of Cardiology criteria—the remainder were inappropriate or uncertain.

In another Economix Blog post, Catherine Rampell gives some data on CT use rates per capita in other OECD countries. The US leads the pack by quite a bit and the same gap (and likely the same situation of overuse) is true for MRI rates.