Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Department of Family Medicine and Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
J Gen Intern Med. 2019 Sep;34(9):1910-1912. doi: 10.1007/s11606-019-05099-z. Epub 2019 Jun 26.
Despite improved knowledge about the benefits and harms of treatments for chronic back pain in the past several decades, there is a large and consequential mismatch between treatments found safe and effective and those routinely covered by health insurance. As a result, care for back pain has, if anything, deteriorated in recent decades-expenses are higher, harms are greater, and use of ineffective treatments is more common. Deficiencies in health care delivery processes and payment models are centrally involved in the failure to improve care for back pain. A key step for accelerating progress is changing insurance coverage policies to facilitate use of the safest and most helpful approaches while discouraging riskier and less effective treatments. Relatively simple changes in reimbursement policies may minimize harm and improve quality of life for many patients with chronic back and similar pain syndromes. Such changes might also reduce health care expenditures because the costs of treatments currently covered by insurance and their associated harms may well outweigh the costs of the relatively safe and effective treatments recommended by current guidelines but poorly covered by insurance. There is no justification for continuing the status quo-patients and clinicians deserve better.
尽管在过去几十年中，人们对慢性背痛治疗的益处和危害有了更多的了解，但在已被证明安全有效的治疗方法和医疗保险常规覆盖的治疗方法之间，存在着巨大且重大的不匹配。结果，近年来，背痛的治疗情况如果说有什么变化的话，那就是情况恶化了——费用更高，危害更大，无效治疗的使用更为普遍。医疗服务提供流程和支付模式的缺陷是导致未能改善背痛治疗的核心因素。为了加速进展，一个关键步骤是改变保险覆盖政策，以促进使用最安全和最有效的方法，同时抑制风险更高和效果较差的治疗方法。报销政策的相对简单的改变可能会最大限度地减少许多患有慢性背痛和类似疼痛综合征的患者的伤害，并提高他们的生活质量。这些变化还可能降低医疗保健支出，因为目前医疗保险覆盖的治疗方法及其相关危害的成本很可能超过当前指南推荐但保险覆盖不足的相对安全有效的治疗方法的成本。继续维持现状是没有道理的——患者和临床医生应该得到更好的治疗。
