(Seeing a specialist for a common condition can get expensive quickly — but it doesn't have to be like that.Jim Bourg/Reuters)
Republicans in Congress are working to overhaul the US healthcare system, particularly by making large cuts to government programs like Medicaid.
Dr. Jamie Koufman has her own idea about how to curb healthcare spending. And while Republicans are looking to reduce spending through cuts to health plans, Koufman's solution hinges a lot more on the people who actually care for patients.
The answer: Cut down on the number of specialists patients see for conditions that only need a primary care doctor to look at. The way the current healthcare system is set up, people pay for each visit to the doctor. Visiting specialists for cases that might not warrant them is one way costs to the healthcare system are being driven up.
"Most Americans mistakenly believe that they must see specialists for almost every medical problem. What people don’t know is that specialists essentially determine the services that are covered by insurance, and the prices that may be charged for them," Koufman wrote in an op-ed for The New York Times.
Here's how it works. Koufman is the director of the Voice Institute of New York and a professor of otolaryngology (the field of medicine that deals with diseases and disorders related to the ear, nose, and throat) at Mount Sinai. Through her work, she sees a lot of cases of acid reflux, a disease in which the acid in the stomach irritates the lining of the esophagus.
It's a common condition: About 20% of the US population experiences it on at least a weekly basis. But for how common it is, getting reflux diagnosed and treated can often be a lengthy (and often expensive) process, she's found. Here's what tends to happen before they come to her (emphasis ours).
"The focus of my practice is acid reflux that affects the nose, throat and lungs, so-called respiratory reflux. By the time patients arrive at my office, most have already seen otolaryngologists, pulmonologists, gastroenterologists and allergists. They have undergone unnecessary CT scans, MRI’s, blood work, allergy tests, asthma treatments, endoscopies, and nasal and sinus surgeries. Each specialist performs the procedures that generate income for them, and then passes the patient along.
"But when it comes to managing acid reflux, specialists offer no advantage over primary care physicians. Indeed, sometimes all a patient needs are basic changes in diet, lifestyle and sleep."
So, essentially, in many cases, all of that extra expense from tests and co-pays wasn't necessary. The same kind of spiraling healthcare costs can happen in other really common conditions as well, such as headaches, colds, sore throats, etc., Dr. Richard Isaacs, CEO of the Permanente Medical Group, Kaiser Permanente's physician group, and a head and neck surgeon told Business Insider.