Healthcare Trade-offs

Hope for Balance - Bob M

Blog by Colin Hung

I am a baseball fan. I love playing the game and I love watching it (though sadly I’ve done more of the latter than the former in recent years). For fans of Major League Baseball, July 31st marks the mid-summer trade deadline. It is the last day that teams can trade players without using the waiver wire (a more difficult way to make trades).

This trade deadline got me thinking about the nature of trades – how each team making the trade seeks to gain something they want in return for something they are willing to give up. The most successful trades are ones that are balanced. One team, for example, may be willing to trade potential stars of the future for proven players who can help them win now. It’s an exciting time for baseball fans.

Trades or more accurately trade-offs are common in healthcare. Clinicians, administrators, caregivers, government bodies and even payers make choices every day that impact the health of patients. In fact, patients themselves make trade-offs when it comes to their own health and care.

Oxford Dictionary defines trade-off as:

  1. the act of balancing two things that are opposed to each other
  2. something bad that you have to accept, or something of value that you have to lose, in order to have something good

Both kinds of trade-offs happen every day in healthcare. Clinicians have to make the trade-off between potential positive outcomes and potential risks. Administrators have to balance financial solvency with the needs of staff and patients. Patients have to choose between care options that they often know very little about.

This week on #hcldr I thought we would explore the nature of trade-offs in healthcare. For example, how far would you go to get quality care? Would you drive 2hrs to a clinic that provided better care/outcomes? How about 4hrs? How about outside the country?

Many patients in North America face tough decisions relating to medication. In a recent CDC study, 8% of US adults choose to not take their medications as prescribed in order to save money. In 2013, US News published an article that put the spotlight on the extremes some families have to go to in order to afford medications including forgoing groceries and paying rent. I can’t imagine having to make that kind of trade-off.

Thankfully there are some resources available online that are designed to help patients make these types of tough decisions. The Children’s Hospital of Eastern Ontario for example, has a wonderful page of links to healthcare decision aids (many from Healthwise and AHRQ).

Patients aren’t the only ones making tough trade-offs, clinicians are often placed into situations where they have to choose between following “the rules” of their organizations vs doing “what’s right” for their patients. Worse, in some remote areas where resources are in extremely short supply, they have to trade-off community health vs individual health. Again, I can’t even imagine making that kind of decision.

We have discussed various kinds of trades before on #hcldr:

Join the #hcldr weekly tweetchat on Tuesday July 28th at 8:30pm Eastern (for your local time click here) where we will discuss the nature of trade-offs in healthcare:

  • T1 How would you choose between quality vs convenient care? How far would you travel to get good care?
  • T2 As a clinician, if you saw a rule/policy that was counter to patient health, how would you bring attention/address it?
  • T3 What difficult health decision have you had to make? How did you decide your path forward?
  • T4 How can healthcare orgs/clinicians help patients in making difficult healthcare decisions?

Resources

“High Medical Bills Driving Some Americans to Extreme Measures”, Karen Pallarito, US News, January 18 2013, http://health.usnews.com/health-news/news/articles/2013/01/18/high-medical-bills-driving-some-americans-to-extreme-measures, accessed July 25 2015

“Strategies Used by Adults to Reduce Their Prescription Drug Costs: United States 2013”, Robin Cohen and Maria Villarroel, CDC NCHS Data Brief, January 2015, http://www.cdc.gov/nchs/data/databriefs/db184.pdf, accessed July 25 2015

“The Soaring Cost of a Simple Breath”, Elisabeth Rosenthal, New York Times, October 12 2013, http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html?pagewanted=all&_r=0, accessed July 25 2015

“Traveling for healthcare, but not that far”, Chris Taylor, Reuters, Jan 18 2013, http://www.reuters.com/article/2013/01/18/us-healthcare-travel-idUSBRE90H0UP20130118, accessed July 25 2015

“It’s a Trade-Off, Stupid” Saurabh Jha MD, The Health Care Blog, September 25 2014, http://thehealthcareblog.com/blog/2014/09/25/its-a-trade-off-stupid/, accessed July 25 2015

“It’s time to talk trade-offs in health care”, Saurabh Jha MD, KevinMD.com, October 10 2014, http://www.kevinmd.com/blog/2014/10/time-talk-trade-offs-health-care.html, accessed July 25 2015

“Tradeoffs in healthcare decision-making”, Institute for Healthcare Policy & Innovation – University of Michigan, http://ihpi.umich.edu/initiatives/tradeoffs-healthcare-decision-making, accessed July 25 2015

Image Credit

Hope For Balance – Bob M, https://flic.kr/p/rDRPnV

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