The Health Care Blog: Carrot or Stick? Should Patient Decision Aids Be Rewarded or Required?

By DON KEMPER

1. Should we incent or require providers to prescribe patient decision aids?
2. Should we incent or require consumers to use patient decision aids?

Overtreatment is the most celebrated cause of runaway health care costs, but we shouldn’t blame the doctors. The fee-for-service system sets them up for overtreatment. First, they have been taught that offering all possible cures to every patient is good medicine. Second, malpractice law pushes them toward offering more testing and services, not less. And third, they generally get paid more when they do more. It’s hard to buck a triple-threat system like that without a little help from the patient. Fortunately, it’s not that hard for patients to provide that difference.

Patient decision aids are tools that help people participate with their doctors in key medical decisions. These aids are useful when there is more than one medically reasonable option to diagnose or treat a health problem—particularly when the options have different costs, risks, or benefits that some people might value differently than others.

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