Should cost considerations be included in medical decisions? Yes

Excerpt

The inexorable rise in healthcare costs as a proportion of national wealth is a trend that is increasingly recognized as being unsustainable [1]. Healthcare leaders have a critical role if this problem is to be addressed. At first glance, linking healthcare quality improvement to payment appears straightforward. Improve the care that one provides to one’s patients and one is rewarded financially, but this strategy assumes that clinicians and administrators possess the necessary tools and knowledge, and that the delivery system has the necessary levers. In fact, as stated by Cohen et al. [2], “although health-care workers and hospitals are publically committed to reducing inappropriate care, improving patient safety, achieving better health outcomes, and holding down costs, many are unsure how to do this effectively”. Moreover, this approach can underestimate healthcare system complexity and, in extreme circumstances, contribute to unintended and very harmful adverse outcomes through misaligned incentives, as occurred in the Mid Staffordshire Hospitals in the UK in the early 2000s [3]. …