Uncategorized

Gawande Nails It on Healthcare Costs

Wachter pic (informal)I just finished reading Atul Gawande’s June 1st New Yorker piece – it’s the Talk of the Health Policy Town – on healthcare’s “Cost Conundrum.” Like most of Atul’s work, the article is lyrical, powerful, insightful, and correct.

As you’ve probably heard, Gawande profiles the town of McAllen, Texas, whose healthcare costs are nearly double the national average. He swats away the usual explanations (our patients are sicker, more obese, more addicted, more Mexican; our lawyers are nastier; our quality is better…) to unblinkingly zoom in on the real culprit: a culture in which providers’ greed trumps the patients’ interests. He contrasts McAllen’s healthcare culture with that of El Paso, just 800 miles up the border, a town with similar demographics but whose healthcare costs are exactly half as high. He also describes the Mayo Clinic, which manages to deliver the best healthcare in the country, perhaps the world, at a fraction of McAllen’s costs.

His main point is that policymakers need to focus less on who pays (i.e., should there be a “public plan”?) and more on creating physician-led accountable entities that manage the dollars and possess the wherewithal and incentives to make rational choices about how to organize care – the ratio of primary care docs to specialists, the number of MRI scanners, the algorithm for the workup of chest pain or gallstones. Atul understands that we can’t snap our fingers and change culture, but that culture will change when structure and incentives are lined up correctly.

The article is both hopeful and depressing. Hopeful because it says that in order to save healthcare costs from bankrupting America, we don’t need to look to Germany, or Denmark, or Canada for inspiration – the models for how to deliver high quality care at a survivable cost are already here, in the good ole’ U.S. of A. We simply need to create a policy landscape that either forces McAllen’s providers and healthcare organizations to become more like El Paso’s (or better yet, Mayo’s) or makes their businesses unviable if they don’t.

Depressing, because in the absence of vigorous federal action, the docs and administrators in El Paso are more likely to start behaving like those in McAllen than the converse. Why? If the healthcare pie begins to shrink, we can expect physicians and communities that have been less profligate to become more entrepreneurial (“why am I being so careful while those other guys reap all the profits?”), not more circumspect.

We won’t have another window to fix healthcare in this generation, and so we’d better take advantage of this one. As I’ve mentioned before, the Obama administration’s game plan is to drive our system toward the optimal quadrant of the two-by-two quality vs. cost matrix: high quality at reasonable cost. This direction is undeniably correct, but the whole thing can feel a bit bloodless and wonky when budget director Peter Orszag explains it. Gawande’s article puts a human face on the issue of cost variations, which makes it an essential read for anyone who cares about healthcare, policy, politics, or the future of our nation.

Robert Wachter, MD, is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Lee Goldman, he coined the term “hospitalist” in an influential 1996 essay in The New England Journal of Medicine. His most recent book, Understanding Patient Safety, (McGraw-Hill, 2008) examines the factors that have contributed to what is often described as “an epidemic” facing American hospitals. His posts appear semi-regularly on THCB and on his own blog, Wachter’s World.

Livongo’s Post Ad Banner 728*90

Categories: Uncategorized

Tagged as:

33
Leave a Reply

33 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
30 Comment authors
купить в минске зеленый кофеHello Hero HackalbertSacramento DentistJames Recent comment authors
newest oldest most voted
купить в минске зеленый кофе
Guest

What’s up, all the time i used to check web site posts here
in the early hours in the break of day, for the reason that i like
to gain knowledge of more and more.

Hello Hero Hack
Guest

This sort of a condition drives one to think out of the box and be
innovative. You can find out more than 2000 games in which do work with
firefox. Some of the games of Kizi1 like Sanrio Photo fun with Hello Kitty App enable you to share some photos and they are really super fun.

albert
Guest

Finding a best
dentist
in El Paso . Dr. Mullen is a familiar dentist in EL PASO .They provide all dental problems , just visit and feel their experience in dentist.

Sacramento Dentist
Guest

Dentists and hygienist alike have an extremely hard time getting pts to follow proposed treatment. However, if patients came regularly to cleanings and took care of fillings early then the dentists and hygienists wouldn’t be able to afford those pretty little cars. I have just found that in general the public isn’t all that accepting of healthcare professionals and that it will always be a struggle for healthcare professionals to get patients to do treatments. Insurance dictates so much of what patients do and want in treatment that sometimes it feels like they are the doctor when they say what… Read more »

James
Guest
James

Good dentists take a personal interest in patients and their health. They are prevention-oriented but not faddists.I live in Mechanicsburg PA and Dr. William Spruill and Dr. Lillian Wong delivered the highest quality dental care while providing a comfortable family environment.
Dentist Mechanicsburg PA

portland dental implants
Guest

Really great lens, I found it very informative as well as insightful. There are numerous methods of dental implants, but i feel the Best dental implants are the dental office options, because you can consult with your dentist beforehand coupled with the expertise and experience, you can be sure to get the best treatment.

Warren McInteer
Guest
Warren McInteer

This is all an excellent debate; we need to focus not on politics , but on taking care of sick people. It is not just doctors – they are not the villans – it is everyone; the doctors, the nurses, the accountants, the CEOs the marketing managers, the dispatch nurses. They all want to maximise revenues and the client’s interests come second. I am an American living in the UK and the difference in the mind set of health care professionals in the US and the UK is huge. Like the Mayo clinic, people in health care here , are… Read more »

Mike McBride
Guest

Find how Healthy Eating can help you loose weight, gain energy, and help your body help it’s self at http://www.shopherbalife.com/freeoffer Give your body what it needs to live a healthy life.

Rocky
Guest

Physical fitness refers to body health, and is the result of regular exercise, proper diet and nutrition, and proper rest for physical recovery.READ MORE :
http://www.manipalcureandcare.com/index.aspx

M.Berger M.D.
Guest
M.Berger M.D.

I have read this article and have tried to find out if the denominator used to determine the frequency of health care was the population of McAllen or some other factor. If the population from the census bureau was the denominator the statistics are inaccurate. The population of McAllen more than doubles from November until April every year with snowbirds. They use healthcare in McAllen since the majority are 65 plus but their residence is recorded as elsewhere. I often see these patients in Austin Texas because they do not want to wait for an appointment in McAllen in the… Read more »

Wayne
Guest

Congress needs to adopt a policy of health care prevention.
Our system is designed to only help after the affliction occurs.
I am a firm believer in nutrition for preventive medicine.
Our people could save a fortune with preventive care.
In other words instead of an aspirin for the pain find the cause of the pain and address the reason.
It is a simple solution and there is much doubt our leaders will adopt such a policy for health care.
After all health care is what keeps our economy going at this point.

Process Engineer
Guest
Process Engineer

Where is the comprehensive study that details the areas of the health care process that can be changed to lower cost? How does the government”s proposal address the changes required to reduce these costs? Will there be undesirable side effects created? What is the cost to benefit ratio? You cannot improve a complex process, such as health care, with arbitrary changes. Without careful study to locate the root cause(s) of the problem and even more careful study of how well the proposed changes address the problem, you will be more like to add new problems without addressing the original problem.… Read more »

Steve P
Guest
Steve P

Dental patients are less diverse than medical patients. Differential diagnosis is more limited, diagnoses less uncertain, treatment options are few in number, accounting is easier, after-hours emergencies are few, scheduled prevention visits dominate. And the real difference: in the ED where I’ve been attending for decades, there is an army of adults who can’t afford dental care of any kind and are therefore invisible to dentists who take care of the occasional charity patients who come to their attention. The unserved and underserved are a huge population. In our community their dental problems are eventually fixed when necessary by oral… Read more »

Santosh
Guest
Santosh

Good One

Deron S.
Guest

And I guess you have no bias whatsoever despite the fact that your wife is a healthcare executive?? Unless I am misunderstanding, most of the stats quoted in the article were based on Medicare cost per Medicare enrollee. That takes away much of the strength of an argument that claims that the area has a higher percentage of silver haired people. Secondly, I find it hard to believe that one of the main goals of the people that make up the “influx” is to get medical care. The bottom line, Colonel, is that you are turf protecting just like nearly… Read more »