WHEN SOMEONE is admitted to a hospital these days, he is likely to be subjected to a battery of tests -- X-rays, electrocardiograms, blood tests and the like -- before being allowed to settle down and rest. Some of those tests may be irrelevant to his ailment. Others may have been done by his physician the day before. None of that matters; all the lab work is routine, an expensive routine that keeps pushing up the costs of health care. But until recently, such practices went unchallenged and unchecked. Medical laboratories, naturally enough, encourage tests. Hospitals and physicians find them handy, reassuring and -- that's right -- routine. Patients may dislike being poked and prodded so much, but the bills are usually being paid by someone else -- an insurance company or a public agency.
Now the Blue Cross-Blue Shield Association, whose member groups paid about $1.3 billion for routine hospital admissions tests last year, is calling a halt. The insurance association has announced that it will stop paying for such diagnostic tests in non-surgical cases unless they are specifically ordered by a physician for a particular patient. The change in coverage, reached in consultation with several medical organizations, should take effect within a year.
The new policy is sensible and welcome. Physicians will still be able to get the diagnostic data they really need or want to have for reasons of medical or legal prudence. But these tests should no longer be administered quite so mindlessly and pointlessly. Hundreds of millions of dollars can be saved, especially if other health-care providers adopt Blue Cross-Blue Shield's approach. One part of the cost spiral can be stopped. Moreover, if some physicians slide into a new routine of ordering up the same old diagnostic battery in every case, professional monitoring groups could presumably spot those patterns and discourage them.
There is a second healthy aspect to the Blue Cross-Blue Shield initiative. It is meant to encourage physicians to rely less on laboratory tests and more on thorough physical examinations of patients, careful taking of medical histories and other old-fashioned diagnostic tools. If that idea catches on, hospital patients may be treated a little less like objects or samples, and more like what they really are -- worried human beings with individual health problems. It's a sad commentary on the hospital system itself that an insurance carrier has to be the one to force a turn toward more personalized care.