If you mean the first issue I raised (providers implementing expensive, might-not-be-effective treatments), I don’t really have the expertise to comment outside the US. As we’ve been saying, it’s a sticky issue. If/when UHC becomes a thing, I would want to see a system where people do have access to treatments that have been proven effective (survival and/or quality of life benefit, specific to the field/symptom of course), but I don’t want to see that money wasted on ineffective or outright nonsensical gimmick treatments.
Of course, when something is currently accepted as effective, everyone (industry, patients, and physicians) any pushback against that will raise an uproar. If an insurance company announced that they would no longer cover (X) because there was no evidence that it was effective, how many people would actually stop to read the fine print and understand the decision? If the gubmit does that, can you just imagine the critics coming out of the woodwork with the sad story of how they couldn’t get (X) because the gubmint insurance wouldn’t pay for it?
Another good example that’s become quite controversial in recent years: placement of stents in patients with “stable” coronary artery disease (i.e. not having a heart attack, but with some mild-to-moderate chest pain and showing a blocked artery on an angiogram). Decades worth of study suggests that the stent does not have a benefit on either survival or quality of life in this population, and the highly-controversial ORBITA study this year showed minimal improvement in exercise tolerance (the last vestige that everyone was clinging onto that justified this practice was basically “well, maybe it doesn’t save lives, but patients feel better after getting stents”)
Yet, thousands of people with stable CAD get stents every year, despite no evidence that these people will benefit from the treatment. It’s become so dogmatic: interventional cardiologists will say “How do you expect me to see a blockage in the (Insert Artery Here) and do nothing?” And even after the ORBITA study was published, holy hell, did that stir up a hornet’s nest. People came out with pitchforks and torches to hammer the people that ran and published the study.
In my world? That study comes out, and the next day, stents in patients with stable CAD are no longer reimbursed by insurance (or UHC). You want it, pay for it yourself. More pipe dreams, of course, but UHC would be a hell of a lot more affordable if we didn’t pay for stuff that’s shown it doesn’t actually work.