More Evidence against the Checkup
How many times did you hear Democratic candidates brag about the new wellness exams for seniors during the last election? All the while claiming that ObamaCare is going to eliminate unnecessary care and make health delivery more efficient?
The results of [the Cochrane review by Krogsbøll et al] are consistent with a previous systematic review by Boulware et al that also evaluated the benefits and harms of general health checks. […] The authors of both reviews reported that general health checks had no effect on mortality, disability and hospitalizations compared with usual care. […]
How should practitioners use the findings of Krogsbøll et al? Although available trials have limitations, there is no convincing evidence that general health checks are beneficial. Since patients who seek or are willing to undergo routine screening are generally healthier than those who are not (indicating that general health checks are least likely to reach those who could benefit the most), and because most people do not receive interventions that are known to be beneficial, general health checks do not appear to be a wise use of scarce healthcare resources. Heeding the Canadian recommendations (made more than 30 years ago) to abandon routine health checks would save money that could be better used by population-level interventions supported by effective health policy, such as the campaigns to reduce dietary sodium in Finland and the United Kingdom.
From a Cochrane Library review editorial via Austin Frakt.
I always wonder what the utility of a check-up is. The general wellness appointment certainly isn’t going to run the necessary tests to detect anything that wouldn’t be obvious to the patient anyway via symptoms.
Basically, don’t go to the doctor unless you are experiencing a problem. Problems that are asymptomatic (i.e. hypertension) will get diagnosed during other routine exams. For instance, if you go to the doctor for the flu, will probably have your blood pressure taken. A “wellness” exam doesn’t actually improve wellness and is therefore basically worthless.
Personally, check-ups have been brief, pointless drop-ins. However, even a check-up that yields all healthy results and lasts less than 5 minutes will be charged around $80 in doctor’s fees.
Let’s be realistic, because the value of health checks vary for each voter, and information asymmetry ensures that people don’t really understand anyway, the obvious choice for a politician is to give them to everyone.
in the aggregate if more people took advantage of early screenings, there would be an emphasis on prevention which would curb higher health care costs in the future.
in the status quo, people that go in for regular screenings more likely because they can afford to. considering that, it is likely that they lead healtier lives and be more preventative in nature.
Funny that the authors recommend against an annual health check up based on the review of the evidence and then go and suggest the saved funds be used for another non-evidence based health recommendation, reduction in sodium.
I believe the misconception people have is that by doing anual check-ups they are preventing every other illness they would have if they didn’t do check-ups at all. What they don’t seem to understand, though, is that these check-ups require so little that these “exams” done during these vistis are not enough to catch any condition, if any.
Most of these check-ups are worthless, not only because patients get nothing out of it, but because physicians get paid for doing nothing. If you want to give your money away, then this is the way to go.
As Milton Recht says, reductions in population dietary sodium? Really?
What about some new, fully staffed, operating rooms so that people don’t have to wait, and wait, and wait for surgery in those countries?
“How many times did you hear Democratic candidates brag about the new wellness exams for seniors during the last election?”
Politics at its finest.
“Because most people do not receive interventions that are known to be beneficial, general health checks do not appear to be a wise use of scarce healthcare resources”
Fix that first part, and the second will go away.
According to the Agency of Health Care Research & Quality, the challenge is really finding the right balance. By extension, this implies avoiding under-use, avoiding overuse, and eliminating misuse. This is something that will change with innovation, so, finding the right construct will be a continuous struggle.
The opening of this blog post appears to make the incorrect assumption that the Medicare wellness visit is an “exam” or a “check-up.” There’s no stethoscope. There’s no coughing sideways. There’s no gloved finger. (You can ask separately and pay a 20% co-pay for a DRE, however.)
Nearly everything accomplished by these medicare “exams” could be accomplished just as effectively by paying the patient $20 to visit a website that would take an automated history and give a printable summary of recommendations. Send a copy to me electronically and I’ll file it in the chart – much happier to pay my staff to do that then to have to endure yet another one of these worthless encounters even if they do pay fairly well.