Patients Whose GP Knows Complementary Medicine Have Lower Costs and Live Longer
A very encouraging article by Peter Kooreman and Erik Baars - GP's in the Netherlands who had also studied Complementary Medicine, their patients have lower costs and live longer!!
A small fraction of general practitioners (GPs) in the Netherlands has completed additional training in complementary medicine after obtaining their conventional medical degree. Using a data set from a health insurer, this paper documents that patients whose GP has additional training in anthroposophic medicine, homeopathy, or acupuncture have substantially lower health care costs and lower mortality rates. The lower costs result from fewer hospital stays and fewer prescription drugs. Since the differences remain once we control for neighborhood specific fixed effects at a highly detailed level, the lower costs and longer lives are unlikely to be related to differences in socio-economic status. Possible explanations are selection (e.g. people with a low taste for medical interventions might be more likely to choose CAM) and better practices (e.g. less overtreatment, more focus on preventive and curative health promotion) by GPs with knowledge of complementary medicine.
Health economists have largely ignored complementary and alternative medicine (CAM) as an area of research, a fact possibly related to the low esteem of CAM in the medical profession. At the same time, however, patients around the globe are increasingly embracing CAM as a contributor to health. A recent study by the US National Institute of Health shows that 4 out of 10 Americans used some form of CAM in 20071. In a
referendum in Switzerland in 2009, two thirds of the voters were in favor of a wider coverage of CAM by public health insurance. By definition, the effectiveness of complementary and alternative medicine has not been proven in clinical trials (e.g., Sing and Ernst, 2008).2 However, lack of proof of effectiveness is obviously not the same as proof of ineffectiveness. Clearly, the status of a treatment can change from CAM into conventional medicine once scientific evidence on effectiveness becomes available. Two examples of CAM treatments that have become ( ore) accepted by conventional medicine are Sint John´s wort and acupuncture for specific indications. Sint John´s wort has become part of the conventional guidelines for the treatment of depression, based on scientific evidence from randomized controlled trials (Linde et al, 2009). Hopton and McPherson (2010) conclude on the basis of a systematic review of pooled data from meta-analyses that acupuncture is more than a
placebo for commonly occurring chronic pain conditions. Also Servan Schreiber (2005) presents a series of recent examples of the transition from CAM to conventional medicine in depression treatment. Some of the methods described by Servan Schreiber have been practiced for centuries, cannot be patented, and are available at low costs. These findings underscore the fact that methods that are considered CAM today could be effective and have a large cost-savings potential. In this paper, we compare the performance of general practitioners who have completed certified additional training in complementary medicine after obtaining their conventional medical degree (GPCs) with general practitioners who have not (GPs). More specifically, we consider GPCs with additional training in anthroposophic medicine (about 2 percent of general practitioners), homeopathy (about 1 percent), or acupuncture (about 1 percent).
Using a large data set from a health insurer we find substantial and significant differences between the health care costs and mortality rates of patients who have a conventional GP and patients who have a GPC. Costs are lower because of both lower pharmaceutical and lower hospital costs. In some cases the cost difference is as large as 30 percent. Since the differences remain once we control for neighborhood specific fixed
effects at highly detailed level, the lower costs and longer lives are unlikely to be related to differences in socio-economic status. We argue that the differences are likely to be due to both selection on unobservables (healthier patients or patients with a low taste for medical interventions might be more likely to prefer a GPC) and better practice on the part of the GPCs (more focus on preventative and curative health promotion, less
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