TW: Part 2 of the Gawande speech focused on diagnosing the key challenges in health care. He touched upon themes about which we blog often- the U.S. spends more but gets less care, the U.S. spending trend is unsustainable. But his primary focus is on how our system encourages and funds testing procedures far higher in frequency than many other countries.
The variation is not merely relative to other nations, however. Gawande finds tremendous variation within the U.S. itself relative to how often and what type testing is prescribed. Some areas test with 2X frequency relative to others, yet health outcomes are not much better if at all. He attributes the higher test frequencies primarily to perverse economic incentives which encourage providers and consumers to seek marginally valuable procedures.
Recall as we say all the time, your cost is someone else's revenue.
New Yorker:
"...More than that, though, we in medicine have partly contributed to these troubles. Our country’s health care is by far the most expensive in the world. It now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government at every level—squeezing out investments in education, our infrastructure, energy development, our future.
As President Obama recently said, “The greatest threat to America’s fiscal health is not Social Security, though that’s a significant challenge. It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”
Like the malnourished villagers, we are in trouble. But the public doesn’t know what do about it. The government doesn’t know. The insurance companies don’t know.
They brought in experts who explained that a quarter of our higher costs are from having higher insurance administration costs than other countries and higher physician and nurse pay, too. The vast majority of extra spending, however, is for the tests, procedures, specialist visits, and treatments we order for our patients. More than anything, the evidence shows, we simply do more expensive stuff for patients than any other country in the world
...health care is not practiced the same way across the country. Annual Medicare spending varies by more than double, for instance—from less than $6,000 per person in some cities to more than $12,000 per person in others. I visited a place recently where Medicare spends more on health care than the average person earns.
You would expect some variation based on labor and living costs and the health of the population. But as you look between cities of similar circumstances—between places like McAllen and El Paso, Texas, just a few hundred miles apart—you will still find up to two-fold cost differences. A recent study of New York and Los Angeles hospitals found that even within cities, Medicare’s costs for patients of identical life expectancy differ by as much as double, depending on which hospital and physicians they go to.
Yet studies find that in high-cost places—where doctors order more frequent tests and procedures, more specialist visits, more hospital admissions than the average—the patients do no better, whether measured in terms of survival, ability to function, or satisfaction with care. If anything, they seemed to do worse.
Nothing in medicine is without risks, it turns out. Complications can arise from hospital stays, drugs, procedures, and tests, and when they are of marginal value, the harm can outweigh the benefit. To make matters worse, high-cost communities appear to do the low-cost, low-profit stuff—like providing preventive-care measures, hospice for the dying, and ready access to a primary-care doctor—less consistently for their patients. The patients get more stuff, but not necessarily more of what they need."
http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html
1 comment:
The United States does spend much more money on health care than most countries, and yet, our citizens are not the healthiest in the world. There is a problem there and we need our country to fix it so people can be healthier and more efficient.
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