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Dr. Sandeep Jauhar offers an interesting historical review of how America's medical system evolved over the last several decades. There are many different facets to the review, but one of the prominent themes that jump out at me is the effect that incentives have on behavior. For example, I was surprised to learn how inflation-adjusted salaries for doctors grew five-fold over thirty years. This rapid rise in compensation coincides with the rise of the employer-funded health insurance. That is, as patients became increasingly divorced from the cost of their health care, health care costs rose. That sounds like it should not surprise anyone, but instead of addressing the problem directly by meaningfully involving patients via cost-sharing, the industry moved towards health maintenance organizations (HMO) to help rein in costs via regulation (e.g. insurer reviews of medical services). Likewise, the industry pricing model has largely been fee-for-service, where doctors are paid by procedure volume. It shouldn't be surprising, therefore, when doctors order unnecessary tests (lamented, for example, by a physician who posted on Sermo). This trend also seems like it would have been curtailed with consumers sharing more of the costs (e.g. "is that CT scan really necessary?").

The sustained rise in health care spending has forced the industry to push more costs onto the consumers. As painful as the transition might be, linking costs with the decision-maker (the patient) seems like one of the few viable methods of meaningfully slowing down health care costs for the long-term. As consumers make better choices when selecting among several options with differing quality metrics and prices, the overall system will become better and more affordable. For consumers to make better choices, however, they will need tools and access to data.

Behind the scenes, we've continued our efforts to improve this site's user interface and those of you who have visited recently might notice that the search results page is different now: we've collapsed the filters into a menu bar. Filters are an important way of helping users find doctors according to specific criteria, so we're keeping them. At the same time, the old filter area would push the search results down quite a bit, so that the search results wouldn't necessarily be visible "above the fold" on a smaller screen.

We'll continue to work on our page layouts (including making the page more responsive). If you have any ideas on what we should prioritize, please let us know.

A number of signs point to increasing transparency within the realm of US health care, especially in terms of pricing. As the cost of health care continues to increase above the rate of inflation, employers have been shifting costs onto their employees -- via less subsidy for premiums, higher co-pays, higher co-insurance, and/or higher deductibles. As employees realize that their decisions have serious financial consequences, they will become more informed and engaged. As they continue to ask for pricing information, such information will (eventually) become more available. The journey, however, isn't always smooth. Modern Healthcare published an article about how doctors are finding that an increasing portion of their time with patients is spent discussing financial matters, and that patients will sometimes push for less effective tests or treatments in order to save money.

This is an indication that financial considerations are becoming more important to the patients (who, up until relatively recently, could often rely on their insurance companies to cover most of the bill). With doctors starting to complain about figuring out costs, maybe more insurance companies will move faster in unveiling easy-to-use cost calculators.

Health Affairs published a study on patients who needed MRIs. The major insurer who participated in the study offered one group of patients information about which providers offered the procedure at lower costs; the control group continued to not have easy access to that information across providers. The unsurprising result was that areas where the insurer that offered information, experienced decreases in the cost of MRIs (even for patients who didn't participate in the study). The prices in the areas of the control group? Those prices went up.

I didn't read the study, but an additional detailed covered here indicates that patients who were offered prices about the procedure were not penalized for selecting a higher-cost provider. If that means that patients paid the same amount out-of-pocket regardless of whether they went to a low-cost provider or a high-cost provider, then the study suggests the somewhat surprising conclusion that patients are willing to save money even when it's not their money. What's more surprising, however, is that health insurers have waited so long to roll out pricing information.

We're always on the lookout for interesting information to integrate. Recently, we've worked on integrating information from the New York State Department of Health. While most of the information is about hospitals, there is some actual outcomes data about cardiothoracic surgeons. They also released "expected mortality" (expected number of deaths given the patient mix), which we've chosen to display case severity. Even though this is one specialty in one state, we're excited that at least one government agency is now disclosing actual outcomes data in a downloadable format.

If you're interested in trying out this feature, search for "heart bypass surgery" in New York.