The New Yorker has an excellent article on health care costs. It focuses on the Hildago county Texas area and it’s main city McAllen. This area has the second highest health care costs, as measured by health care spending, in the USA. It is second only to Miami. This is in stark contrast to El Paso county, about 800 miles up the Rio Grande, a place with very similar demographics. The spending in Hildago county is roughly twice that of El Paso county. Are the citizens of Hildago county getting better care for all the extra spending?
Where is the money going?
Read the article. The root cause is revealed in the first page or so.
But don’t stop there, near the beginning where, the high cost culprit is revealed. Author Atul Gawande goes on to speak to his own experience as a doctor, when he bullied an admitting physician to keep his son overnight for observation. This hospital stay, he realized after doing further research, was unnecessary. Dr. Gawande also examines the practices of the Mayo Clinic and practitioners in Grand Junction Colorado. Both of these have costs among the lowest in the nation while providing care that is close to the top available. Those cases, where high quality care is provided at low cost, are the truly instructive ones.
Nor are these two cases special instances that cannot be repeated elsewhere:
Grand Junction’s medical community was not following anyone else’s recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls 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.
This approach has been adopted in other places, too: the Geisinger Health System, in Danville, Pennsylvania; the Marshfield Clinic, in Marshfield, Wisconsin; Intermountain Healthcare, in Salt Lake City; Kaiser Permanente, in Northern California. All of them function on similar principles. All are not-for-profit institutions. And all have produced enviably higher quality and lower costs than the average American town enjoys.
The money quote: “[Lester Dyke, cardiac surgeon], is among the few vocal critics of what’s happened in McAllen. “We took a wrong turn when doctors stopped being doctors and became businessmen,” he said.
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