Question:

As you read the "A Pain in the Back" case study on pages 25-26 of Economics for Healthcare Managers, reflect on your own experiences as a caregiver or a patient.

In your journal post, answer the questions included in the case study. Think about how you would have answered the questions as a mere consumer, then how you would answer them now that you have been informed through the reading. How would this knowledge gap change your answers if you were a caregiver for a loved one as opposed to if you were the patient?

For additional details, please refer to the Journal Rubric document in the Assignment Guidelines and Rubrics section of the course.

Americans with back pain are using more pain-killers, having more surgeries, and undergoing more imaging studies (magnetic resonance imaging and computed tomography) than ever, yet they do not appear to be feeling better. In 2005, patients with back problems reported more limited functioning than patients did in 1997, even though inflation-adjusted spending was up more than 60 percent (Martin et al. 2008).

Neck and back pain are common, and a majority of adults have an episode during the course of a year. Neck and back pain are also common reasons for physician visits. During these visits, physicians usually (or should) reassure patients that most low back pain improves with conservative treatment (a combination of ice and nonprescription pain relievers, followed by moderate strengthening and stretching exercises that can be done at home without special equipment). Diagnostic imaging is being prescribed more frequently for patients with back and neck pain, even though the value of imaging appears to be limited (Carragee 2005). Few imaging studies yield a definitive diagnosis or a new treatment plan. Furthermore, Medicare data show that rates of back surgery have increased dramatically, even though there is little scientific evidence that surgery is superior to conservative treatment. The United States has the highest rates of back surgery in the world, even though back problems are no more common here than in other countries. In addition, surgery rates also vary greatly between cities. For example, in 2010, the back surgery rate for residents of Fort Myers, Florida, was 140 percent higher than the rate for residents of Miami (Dartmouth Atlas of Health Care 2014).

Discussion questions:

• If imaging followed by surgery is as effective as conservative therapy, what's wrong with letting physicians and patients do what they want? 
• What explains this rise of imaging and surgery for back pain? 
• Who makes decisions about surgery? 
• Should insurers take action to reduce surgery rates? Should individuals? 
• How do providers' revenues change if imaging and surgery rates rise? 
• How do patients' costs change if imaging and surgery rates rise? 
• How do current incentive systems affect physicians' and patients' decisions?