Monday, June 1, 2009

Another look at the sources of health care cost increases

I guarantee you'll feel more like a communist --- and I mean that in a good way --- after you read Atul Gawande's latest piece in the New Yorker. He argues that patterns of considerably higher medical costs and higher rates of cost inflation in one Texas border county as compared with a neighboring county suggest that the economic motivation of hospitals and doctors are key.

Some usual suspects, at least that produce higher cost levels but not necessarily growth rates, are sicker populations and differences in medical training. The latter is kind of what Gawande is talking about, because he cites the Mayo clinic and other organizations that put physicians on salaries and then "team-heal" their patients, which is similar to the style of practice one would learn in medical school. This in contrasted with the model in which physicians order procedures and tests for patients and then pocket whatever Medicare or insurance reimburses themselves individually --- what Gawande believes is driving higher costs in one border county.

It's hard to believe the problem would be attributable to just one element of caregiving, but Gawande makes a pretty impressive case for it. What I found interesting was his vignette about how his own (New England) training was for more cautious, perhaps unfoundedly so, medicine than what he and his family received while on vacation in another part of the country. He didn't really address how important that might be, and one certainly suspects that it might be important for high-cost but also probably low-profit areas like New York City.