David Williams has written an excellent article about the overuse of mammography screening in older women with cognitive impairment. When you read his article, especially the part about how women with a higher net worth are more likely to be screened, it’s obvious that money is playing a large role when it comes to determining who should get mammograms. Common sense indicates that we shouldn’t be exposing a person with a short life expectancy and cognitive impairments to mammograms – or much else in the way of screening tests, in my opinion. The focus should be on comfort and dignity instead.
But imagine if health insurance companies and the government (via Medicare) were to implement restrictions on screening tests based on a person’s overall health and life expectancy. I’m sure there would be quite an uproar, with talk about death panels and pulling the plug on granny. Regardless of the actual merits of such limitations, I can’t imagine that they would be well received by the general public. And new guidelines would likely be highly distorted by people who have a financial stake in as many screening exams being done as possible, regardless of how helpful the exams actually are.
I can see the other side of the problem too – mainly that health insurance companies and Medicare/Medicaid could go overboard with regulations, refusing to cover screenings for people who might actually benefit from them. There isn’t a clear cut answer to problems like this, but that doesn’t mean we shouldn’t look for solutions anyway.
David’s article was included in the Cavalcade of Risk this week, hosted by John Leppard at Healthcare Manumission.
