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Easy health reform; Reducing unneeded X-rays, CT scans can lower costs and benefit patients

One of the reasons why real health care reform has seemed such a tough nut to crack is that it involves two seemingly contradictory goals. We want better care. And we want it to cost less.

But, in at least one area of medicine, there is reason to believe that cost-cutting, intelligently done, will actually improve the long-term health prospects of many Americans.

As outlined in an Associated Press investigation that ran on the cover of Sunday's Viewpoints section, doctors in the United States order, and their patients receive, many more X-rays and CT scans than do their counterparts in other industrialized nations.

These methods of looking inside the body without making incisions or resorting to wild guesses are rightly considered among the most useful miracles of modern medicine.

But every time we roll these machines out, we expose the frail human body to another dose of radiation, which can increase the likelihood of cancer. And we expose the health insurance companies, our employers, our government and ourselves to another diagnostic expense.

Put the two together, and we have a formula for spending too much money on a practice that is supposed to make us well but increases the chances that we will get very sick.

When the test is necessary, the health and financial benefits outweigh the cost. But when the test is not necessary -- when it has been done several times already, when other equally useful means of diagnosis are available, when the treatment was going to be the same with or without the additional data -- it is all cost and no benefit.

And often, doctors are beginning to figure out, even tests that ought to be done often carry a much larger dose of radiation than was necessary to figure out what is making our chests hurt or our stomachs tender.

Some tests are ordered for many reasons that, upon reflection, seem unwise. Doctors are defending themselves against malpractice suits they might suffer for missing something important. They don't know what tests have already been done, or cannot easily get a copy of the old image and find it easier to order another.

Getting a handle on this problem is just the sort of thing that will be addressed by the move toward electronic medical records -- one leading example being the Western New York-based HEALTHeLINK project. Tracking the number of scans each patient has had -- and the amount of radiation used each time -- will help doctors make more intelligent choices about how many pictures they should take, what other images already exist, and how much radiation an individual patient has been exposed to over many years, or even over a lifetime.

Setting up systems such as HEALTHeLINK costs money, of course. But, once in place, they can go a long way toward reducing both unnecessary doses of radiation and cutting the costs of practicing good medicine.

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