To the editor:

Many of the problems mentioned in your April 10 article on inadequate health insurance should ultimately be resolved as the new reform law is implemented. An equally serious problem is over-insurance, which has long been a major driver of the unsustainable growth in health care expenditures, and which could potentially accelerate as we approach universal coverage.

During my 25 years in health care management, it has been my observation that a major cause of spiraling costs is lack of patient financial responsibility. Otherwise savvy consumers seem to check their shopping skills at the door of a health care facility, especially when insurance is paying 100 percent of the bill.

Patients with insurance rarely question what services will cost, what the alternatives are to suggested tests and treatments, or what the likely benefits are. While this passive approach can sometimes lead to negative health outcomes, it very often leads to unnecessary costs that must be borne by other insureds, employers, taxpayers, and consumers.

People who pay a significant portion of their health care expenses out of pocket tend to be more conscious of costs, and ask more questions about the value of recommended tests and treatments. Given adequate information, patients usually make good decisions about whether to incur additional costs.

If each patient has some financial skin in the game, health care costs for everyone will certainly be reduced, and I suspect the population will ultimately be healthier due to the elimination of complications resulting from unnecessary testing and treatment.