So this practice is made more obvious in the US, simply because individuals are left with the bill. Although having a single-payer (i.e. universal health care) system might help to identify these patterns and reduce costs, the fact is that it occurs all the time, even in these systems. I'd be willing to bet that it happens more often in single-payer systems, simply because it's easier to justify and get away with. When I volunteered in the ER, I saw it all the time.
In fact, I remember when I was preparing to apply for med school in Canada/Ontario, I had to read a number of articles, journals, and books about medical ethics, and one thing that stood out was the consistent push to have future physicians account for the impact of their decisions on the system as a whole. So not only was it imperative to promote patient health, but it was also important to balance that with the overall cost. A good example is a simple blood test. A full spectrum blood test may help identify potential problems in a patient, but it costs OHIP a lot of money to run those tests (especially since they're done in private for-profit labs). That's why your family doctor should really only order the required tests.
> the fact is that it occurs all the time, even in [single payer] systems
The "single payer" has a hell of a lot more leverage than individuals in the US which, as far as I can tell, don't need to consent in any way (hell, they can even explicitly refuse to consent) and get stuck with the bill regardless. That trick wouldn't work so well on an organization the size of the government.
I completely agree, but how likely is it that big government will be able to accurately audit whether a procedure was actually required or not? In fact, I'd prefer if big government would stay out of it and just pay for my healthcare to keep me healthy & alive. I am not an expert on the procedures I need, and neither is big government. We put our trust in medical practitioners to make those decisions for us. The problem is that they benefit financially from those decisions.
If you ask me, the answer is to stop conducting these services as fee-for-service. Pay physicians a salary. Pay them well, but keep costs somewhat fixed.
Turns out medical practitioners are not experts either. There are plenty of health situations where you can get treatment A or treatment B and the only thing deciding that choice is the doctor's personal preference and that might have nothing to do with best patient outcomes.
You need organizations like Cochrane or NICE to provide evidence based guidance.
In fact, I remember when I was preparing to apply for med school in Canada/Ontario, I had to read a number of articles, journals, and books about medical ethics, and one thing that stood out was the consistent push to have future physicians account for the impact of their decisions on the system as a whole. So not only was it imperative to promote patient health, but it was also important to balance that with the overall cost. A good example is a simple blood test. A full spectrum blood test may help identify potential problems in a patient, but it costs OHIP a lot of money to run those tests (especially since they're done in private for-profit labs). That's why your family doctor should really only order the required tests.