Incorporating cost considerations into medical decision making

The costs of healthcare have risen dramatically over the past several decades. In the United States, for instance, it is estimated that costs this year will exceed $28 Billion. Additionally the proportion of a family's income dedicated to healthcare costs have risen at a far greater pace than other household expenses; corporate profits have been trimmed by costs for their employees health; and Medicare and Medicaid are buckling under the strain. It is clear that costs must be trimmed in order to avoid a bursting bubble that might put public health at risk. The current 'solution'---payer controlled cost cutting using rationing founded upon the results of cost-effectiveness assessment---is less than ideal and ethically concerning. An alternative solution wherein costs are considered as part of the medical decision-making process between patient and physician is presented in this chapter.