You and Your Doctor

YOU AND YOUR DOCTOR….Tyler Cowen says that one of the reasons for rising healthcare costs is that people object to any limits on the amount of care they can get. Matt Yglesias demurs:

While people will naturally always want “all the care they want,” people’s desire to obtain health care is large part a result of their interaction with the health care system. If I’m feeling ill and want the doctor to prescribe me some antibiotics, but then he says “no no no, you have madeupitis and if you take antibiotics you’ll die” then suddenly it seems I don’t want the antibiotics anymore. Medical treatment isn’t fun, people don’t just want treatment for no reason. If you convince them that the treatment isn’t useful, they really won’t want it.

This is a common response on the left, but I’ll confess to some curiosity about it. I happen to agree with Matt, but that’s largely because I, personally, labor under a considerable fear and loathing of doctors. (OK, more loathing than fear, actually.) I avoid seeing doctors unless I absolutely have to, I don’t like taking medication, and I basically feel that the least possible medical care is the best possible medical care. Put me in a hospital and all I want to do is get out before the staff kills me with a central line infection or a misfilled prescription. (Tell me again: why, exactly, is it that doctors seem to think it’s cute that they have unreadable handwriting?)

But that’s just me, a relatively healthy middle-aged guy, and the fact that I feel this way isn’t an especially good guide to public policy choices for a trillion dollar industry. So would any GPs care to chime in on this? Do patients typically tend to demand boatloads of care they don’t really need? Do they insist on taking drugs that won’t help them because they saw them on teevee? Do they come back over and over and over until you finally cave in and provide expensive new treatments that are vanishingly unlikely to do any good?

As it happens, there’s a fair amount of research to back up my neurosis-based view that patient demand isn’t a huge factor in rising healthcare costs. A famous RAND study, for example, suggests that free healthcare has only a modest impact on demand for services, and other research fairly convincingly indicts supply-side issues (more doctors = more healthcare), institutional issues (intensive marketing campaigns from pharmaceutical and device firms), and incentive structures (if you pay doctors for prescribing services, they’ll prescribe more services), among others.

Still, demand-side issues aren’t trivial, especially for the over-65 crowd, which accounts for the majority of healthcare spending. So what are patients like on average? Are most of them like me and Matt, eager to avoid medical care unless it’s absolutely necessary? Or are we outliers? Comments?