4 ms·

I honestly think the aversion to screening has more to do with other political and economic factors. For example, lung cancer screening has been shown to clearl

I honestly think the aversion to screening has more to do with other political and economic factors. For example, lung cancer screening has been shown to clearly reduce all-cause mortality in an extremely comprehensive study with 7 years of followup (NLST). These results are also replicated in studies around the world. The problem is, how do you properly incentivize patients, providers and payers to actually implement this? The payoffs are not immediate but are rather long term for everyone involved: it takes 6+ years to clearly see the significant mortality reduction payoff actually show up in the data. The downsides, on the other hand, are immediate (another trip to the hospital/imaging center, deaths due to false positives, increased costs, more work for clinicians).

toast0 6y ago
Incentivising patients should be the easiest part. People, generally, would like to live longer, and if you make imaging convenient and work on the messaging, you can get good compliance, at least for the screening part; compliance for interventions would still be an issue, I presume. For providers, provide the studies and incentives. Bonuses for lung cancer screening work, or % of patients screened (of eligible patients seen above age X, who haven't been screened, don't have a counter indication to screening, etc). For payers, I think there's two classes of payers; long term payers like national health services; and short term payers like US health insurance where people can change insurance every year. Long term insurers can (and should) be looking at their budgets and data (their own, but also studies like you mention) to find out what things to prioritize. Depening on your perspective, goals could be to maximize good years of life given the budget or to minimize future budget needs given the current budget. Short term payers are going to have a hard time prioritizing long term issues. Reducing future costs for your insurance pool doesn't help you much when your pool can change every year. To incentivize this through economics, we would need to somehow increase the time exposure of the provider. Something along the lines of the insurance carried for a given year has partial responsibility for future years. Of course, that would be an administrative nightmare.
- dontreact 6y ago
  So Medicare already fully reimburses screening and yet only 3% of the eligible population gets screened. Imaging convenience is a bit chicken and egg. Not sure how you get the bonuses you are describing to happen. It seems to me like no one really is caring enough to make it happen.

toast0 6y ago

Incentivising patients should be the easiest part. People, generally, would like to live longer, and if you make imaging convenient and work on the messaging, you can get good compliance, at least for the screening part; compliance for interventions would still be an issue, I presume. For providers, provide the studies and incentives. Bonuses for lung cancer screening work, or % of patients screened (of eligible patients seen above age X, who haven't been screened, don't have a counter indication to screening, etc). For payers, I think there's two classes of payers; long term payers like national health services; and short term payers like US health insurance where people can change insurance every year. Long term insurers can (and should) be looking at their budgets and data (their own, but also studies like you mention) to find out what things to prioritize. Depening on your perspective, goals could be to maximize good years of life given the budget or to minimize future budget needs given the current budget. Short term payers are going to have a hard time prioritizing long term issues. Reducing future costs for your insurance pool doesn't help you much when your pool can change every year. To incentivize this through economics, we would need to somehow increase the time exposure of the provider. Something along the lines of the insurance carried for a given year has partial responsibility for future years. Of course, that would be an administrative nightmare.

dontreact 6y ago
So Medicare already fully reimburses screening and yet only 3% of the eligible population gets screened. Imaging convenience is a bit chicken and egg. Not sure how you get the bonuses you are describing to happen. It seems to me like no one really is caring enough to make it happen.