The Dumbing Down of Healthcare

  • by: |
  • 04/07/2008
I have great respect for the work of John Wennberg and Elliot Fisher at Dartmouth. Their work has underscored that some clinical practices which are entrenched by tradition or local relationships between doctors and hospitals are not the most effective compared to others. But there is a bit of hubris creeping into their more recent analyses which presume that if we standardized care to cheapest providers of care to those who die within 2 years of a subjectively determined time we could save 20 percent of Medicare spending.

First, as a patient I would like to know which care is associated with not dying within the two year time frame. And as a methodological issue, the failure to compare cost of patients receiving the same care for the same disease without adjusting for severity of illness is a big one. Accordingly, recommending ways to reduce overuse of acute hospital care without knowing what works to improve outcomes -- not always a cut and dried answer -- is probably beyond the data delivered by the Dartmouth group.

Second, Wennberg and Fisher have also looked at gaps in providing effective care that contributes to longer life. If those gaps were filled it would cost more money. And if people lived longer they would ultimately wind up with a disease that could be expensive to treat. More people receiving better care, more preventive screenings, etc. all adds up. They should be more persistent in coupling that message with their other "magic bullet" solutions.

Finally, to claim that more choices lead to higher costs as an article in the WSJ suggested perhaps mistates what the Dartmouth group concludes. The Dartmouth Atlas suggests that regional variations in utilization have nothing to do with better outcomes. But in fact not even the Dartmouth folks presume to tell everyone what sets of practices would work in all situations. Genomic and clinical insights suggest that tailoring treatments and prevention to individual variations improves outcomes. So how could choice be bad?

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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