0 Variations in the cost of medical care: Sense and sensibility

The cost of medical care gets a lot of attention from politicians and policy pundits (including both the influential and people like me); we are often told that Medicare is going to bankrupt the nation, that people are getting unnecessary, expensive, and potentially harmful services (except, of course, when those services are being received by the speaker or writer or those they care about). We are also told that quality and cost control can go hand-in-hand. While sometimes they can, they do not always. As I have noted in the past, prevention does not always save money in the long term. (I guess if we wanted to save money on health care, we’d...

0 The Oregon Lottery: Far from enough, but at least they are doing something

On June 22, 2012, the New York Times published an article on the results of the Oregon lottery. No, this was not your “pick 3” or “powerball”; this was a lottery to get publicly funded health insurance. “In Oregon, Test Case for Health Overhaul, Better Care at a Cost”, Annie Lowrey describes the outcome of Oregon conducting, in 2008, an actual lottery for working-age adults living in poverty to get on to Medicaid. It was not, presumably, intended as an experiment (although certainly people knew that it would end up being one), but rather the result of the state not having enough money to enroll everyone in that category. The results, after 4...

0 Multimorbity, primary care,social determinants, and universal insurance: where they all come together

Tinetti, Fried, and Boyd, writing in JAMA June 20, 2012, discuss “Designing health care for the most common chronic condition – multimorbidity.”[1] They note that adult patients with only a single chronic disease are the exception (e.g., only 17% of people with coronary disease have that as their only chronic condition) and the rate of multi-morbidity increases with aging. However, the medical system is organized around individual diseases, both in terms of reimbursement (based upon International Classification of Diseases, 9th Edition, or ICD-9, codes) and in terms of specialty structure. Thus, cardiologists care for heart disease (only), oncologists...

0 The "Annual Physical": Screening, equity, and evidence

Three articles in the NY Times over a two-day period addressed the circumstances of a person’s (or, in medical parlance, “the patient’s”) visit to the doctor and their expectations. On Sunday, June 3, “Let’s (not) get physicals” by Elizabeth Rosenthal called into question the American habit (?) belief (?) that there is something called an “annual physical” that everyone should get to maintain their health, even if they are not having any symptoms. Rosenthal says that they are not necessary, and can even be harmful, and that the US is virtually alone in the world in perpetuating this idea.She supports her argument by going through a list of tests...