When hospitals and providers decide to use telemedicine as a tool, ROI and cost effectiveness is always a factor. Telemedicine makes it more cost-effective to see our patients and provide a high level of care, so of course that is part of the equation. 

But a recent New York Times article got us thinking. The author does specifically advocate for a thoughtful usage of cost effectiveness data in care decisions. But also he acknowledges that the approach can go very wrong. For instance, he tells the story of an Oregon woman who was denied a $4,000 per month lung cancer treatment by Medicaid because it wasn't deemed cost effective... and then was told that Medicaid would, in fact, cover drugs for physician-assisted suicide since she now had few other options.

Situations like this make many medical providers -- and patients -- want to run for the hills and declare "cost effectiveness" a dirty word.

Despite the US medical system being among the most expensive in the world, we do provide some of the best and most innovative medical care in the world. We've innovated approaches to care that resonate across the planet. And we've all heard horror stories of the illogic and bad care that can happen when providers are treated like factory workers, prioritizing efficiency and cost savings above all else. 

So what is the answer? Should cost effectiveness be considered in care decisions and policy?

Perhaps like everything else, it is an issue of balance. It is clearly unsustainable to ignore cost effectiveness altogether -- and costs in one area of the medical system will eventually affect others. On the other hand, blanket policies that eliminate classes of care are bad medicine and sometimes inhumane. So, as so often is the answer, the providers must use their judgement. Even when it comes to costs, medicine is both an art and a science.