Why cutting costs is so hard in Europe

Rinckside 1993; 4,3: 5-7.

chieving a consensus on the proper use of medical imaging technology in Europe is necessary and worthwhile, both to benefit patients and to reduce health­care costs.

While nobody denies that medical ex­pen­di­tu­res have exploded in recent years, some people – politicians, bureau­crats, ad­mini­stra­tors, and physi­cians – see no need to reduce costs because they believe the increases were accompanied by proportionally better health for all and a higher standard of living. Others believe that we cannot continue to pay for this system and have declared war. They want to see costs brought under control.

The search for the responsible factor or group of persons creating the cost increase is difficult. Many politicians voice the opinion that the explosion is connected to expensive and unnecessary high-technology equipment, but in reality the main contribution to medical costs is personnel. Unlike the automobile or electronics industry, in which computers and robots can be used to lower costs, ra­tio­na­li­za­tion can hardly be employed in medical dia­gnost­ics and treat­ment. Here you required people to take care of patients.

What could be rationalized is the mush­room­ing me­di­cal bureau­cracy and ad­mini­stra­tion, but this is another topic.

High-technology imaging diagnostics contribute less than one percent to the cost of medical care [see postscript below]. One percent may not seem like much but in actual numbers it is billions of ECUs every year (ECU = European Currency Units – or deutsch­marks, pounds sterling, or francs). While it cannot be denied that there are black sheep among the radiologists and other physicians all over Europe making money with unnecessary examinations, a bigger source of misuse results from lack of basic training. More specifically, this misuse ensues from missing overviews and guidelines about which techniques are appropriate for a specific diagnostic question.

   So, the obvious question is: how do we solve this problem?

One relatively easy and nonpolitical solution is to utilize high-technology methods properly. To reach this goal, a consensus has to be established by experts. If the radiologists will not come to terms with the need to create such a consensus and then implement it, somebody else will take care of it in their own way.

In many countries politicians and bureaucrats have already tried to take over, but they have no logical or, in the long run, practical solution. The damage they create is usually limited, although it has become too dangerous to allow them to continue playing with healthcare system.

In one Scandinavian country, the health administration has tried and succeeded in preventing reimbursement for MR brain examinations of psychiatric patients. This is one step too far in the direction of medical bureaucracy dictatorship. It is not the task of bureaucrats to decide which patients should be examined or treated, or which patients should die or survive. Of course, nobody is responsible for such a decision because bureaucrats just hide behind their administration walls.

   On the other hand, it is obvious that public agencies love to make public relation statements on the need to cut costs. But other than making simplistic remarks, they do not constructively contribute to cost-cutting efforts such as helping to create guidelines for the proper use of, for instance, diagnostic imaging methods.

But if you contact the ministries of health or similar institutions in European countries for help you will routinely find that nobody is in charge, although everybody you talk to confirms that an effort to develop guidelines is worthwhile.

And then you will hear the inevitable question: "Why not approach Brussels for support?"

Unfortunately, this undertaking is a low priority task for the Commission of the European Communities.

It would also be worthwhile to reach a consensus for reimbursement and insurance agencies all over Europe. Supporting such an idea is not one of their responsibilities, however. As one of the big German agencies put it:

"It is not our legal task to support such an endeavor." They want to make money.

   So, who is responsible? The radiologists themselves? Why do health administrators shy away from cooperating with physicians to solve the problems of the health system?

It appears that there may be too many of them in the bureaucracy who sit on safe chairs with paid holidays and early retirement plans, and who do not really know what they are doing or want to do, and not really interested in what they are doing.

This mentality also holds for many semi-political physicians' organizations, whose functionaries are also very careful not to step on anyone's toes.

Helping to solve the problem of increasing health costs by creating guidelines for the appropriate use of medical imaging modalities is a relatively small and easy step. But this would, of course, require leadership and support which are in spectacularly short supply on all fronts.

   PS. Within a few years, this has changed. Medical imaging expenses have risen by several hundred percent and constitute a major part of medical expenses.

Citation: Rinck PA. Why cutting costs is so hard in Europe. Rinckside 1993; 4,3: 5-7.

A digest version of this column was published as:
Why cutting costs is so hard in Europe.
Diagnostic Imaging International 1993; 9,7: 5,54.