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McAllen, Texas and the high cost of health care

2 Ratings: 4.5
An article in the New Yorker by Atul Gawande
1 review about McAllen, Texas and the high cost of health...

A different take on improving the quality of healthcare, and controlling the costs

  • Aug 11, 2009
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You might be thinking that you either pay for good care, or you pay less for a system that saves fewer lives.  Atul Gawande, a physician and writer for the New Yorker, proves that we don't have to make that choice, and discusses how to both improve the quality of healthcare, and control the costs.   He approaches this by examining both the absolute worst case (McAllen, Texas), and some of the best cases (Grand Junction, Colorado and the Mayo Clinic).    The critical insight is that great care and low costs are not mutually exclusive, but instead are the natural result of the type of approach taken at, for example, the Mayo Clinic.
Atul paints a picture of two contrasting approaches to medicine -- effectively, two distinct cultures fighting for the soul of medical practice across the country.   In the first, physicians are encouraged to maximize revenue and there is no centralized party advocating for the patient (taken to the extreme in McAllen).  In the second, which he refers to as an accountable-care organization -- "the leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care".
I found Dr. Gawande's explanation of the problem compelling and novel.  The key difficulty, then, is how to promulgate the accountable-care organization, and reduce the incentives that lead to the culture of individual physician profit maximization.  Towards this end, Dr.Gawande claims that much of the health care debate is focusing on the wrong thing -- who is paying.    It doesn't really matter who pays if they pay individual physicians, none of whom is responsible for your overall care.  Each physician will try to optimize his personal revenue from the case.  He argues instead for:
"... rewarding doctors and hospitals if they band together to form Grand Junction-like accountable-care organizations, in which doctors collaborate to increase prevention and the quality of care, while discouraging overtreatment, undertreatment, and sheer profiteering. Under one approach, insurers—whether public or private—would allow clinicians who formed such organizations and met quality goals to keep half the savings they generate. Government could also shift regulatory burdens, and even malpractice liability, from the doctors to the organization. Other, sterner, approaches would penalize those who don’t form these organizations."
The article was brilliant, and a totally different take on the issue.  I highly recommend reading it.

Atul Gawande

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