Health Care: Good Reading

[drscott]

Hat tip Greg Minkow's blog: long but rewarding Atlantic article on health care reform. They killed his father, and the bill was $636,687.75.

Comments

[dr-scott.livejournal.com]

You're referring to this comment, I think: "Most physicians, meanwhile, benefit financially from ordering diagnostic tests, doing procedures, and scheduling follow-up appointments. Combine these two features of the system with a third—the informational advantage that extensive training has given physicians over their patients, and the authority that advantage confers—and you have a system where physicians can, to some extent, generate demand at will."

About diagnostic tests particularly, many people think they are ordered in excess as a CYA maneuver, which helps protect against malpractice suits. I think you're right that it's less commonly directly beneficial to the doctor, though there are apparently places (I'm thinking of Florida) where it's not uncommon for the doctors to own some part of the test facilities, for example for MRIs. This is a Sunbelt phenomenon, mostly, and I suspect it's much more prevalent in retirement areas or places where the population is unsophisticated and fails to question whatever the doctor says.

I think his point about specialists is more that they are highly compensated, while generalists are not well paid for talking to patients, taking histories, doing coordination work, and being patient advocates. The spending stats may not be based on pateint residence but on location of facility, which might wel lessen his point as you say - referrals and travel for complex cases would then tend to make areas where specialists practice more apparently costly. But I think that other studies have shown that it is true that specialists do generate their own demand to some extent, with otherwise similar urban areas showing widely varying costs.