Sherry Chandler

Follow the money

Reports on what’s wrong with our healthcare system most often focus on those people who can’t afford insurance and who therefore have to rely on emergency rooms for treatment. These cases have been presented to us as both highest cost and worst care, because patients tend to put off treatment.

So here’s an eye-opener I found at Washington Monthly this morning. The article is Misdiagnosed by Phillip Longman:

According to a recent RAND study published in the New England Journal of Medicine, uninsured patients receive only 53.7 percent of the care experts believe they should get—that is, appropriate, evidence-based treatment. But according to the same study, patients with private, fee-for-service insurance are even less likely to receive the proper care. Indeed, among Americans receiving acute care, those who lack insurance stand a slightly better chance of receiving proper treatment than patients covered by Medicaid, Medicare, or any form of private insurance.

How is this so? Because, in our healthcare system, doctors are not paid for keeping you well. They are paid for treating your illness, the more terminal, the more lucrative.

How can this be? To answer that question, you need to understand what the insured are actually getting for their health care dollars. One answer: there’s a lot of unnecessary treatment. Dr. Elliot S. Fisher, a Dartmouth Medical School researcher, estimates that 30 percent of all Medicare spending goes for unnecessary operations and procedures. For instance, under Medicare, the per capita cost of treating terminally ill patients in Miami is $50,000 more than the per capita cost of treating equally old terminal patients in Minneapolis, yet the patients in Miami don’t live any longer. The explanation is simply that Miami’s high concentration of specialists and hospitals is overtreating the city’s patients.

Perhaps most shocking: simple preventive care is also lacking in these high-end institutions. They do not recommend aspirin to prevent heart attack, flu vaccines, mammograms. (Because I work in medical research, I can attest that there are some doctors who think simple, inexpensive cures and preventions are neglected because of the symbiosis between big pharma and physicians. But to be fair they are also dealing with a public that is dazzled by technology and drugs.) Care is not coordinated among specialists. And hospitals make a lot of mistakes:

In 2006, the [Institute of Medicine] issued a new study that found that hospital patients in the United States experience an average of at least one medication error, such as receiving the wrong drug or the wrong dosage, every day they stay in the hospital.

I recommend this whole article. It is well-written and filled with eye-openers. And it may change the way you think about the VA medical system.

I must say that I first heard on WUKY, on a program rather mundanely called Dr. Greg Davis on Medicine, the idea put forward that our healthcare system should put more emphasis on paying doctors as much to keep us well as on paying them to treat us after we become horribly ill.

It s an idea of such clarity, so obvious, and I hope it is an idea that is spreading among those who can make things happen. Write your Congress Critters.

Possibly related posts:

The economics of it, the prequel

Why those down-ticket races are so important

The economics of it

The Prayer Study

First do no harm (to those who can pay the bills)

Related posts brought to you by Yet Another Related Posts Plugin.