Tag: "consumer driven health care"

How Psychiatry Went Crazy

The Diagnostic and Statistical Manual of Mental Disorders is often called the “Bible” of psychiatric diagnosis, and the term is apt. The DSM consists of instructions from on high; readers usually disagree in their interpretations of the text; and believing it is an act of faith.

The DSM-II (1968) made homosexuality a mental disorder, a decision revoked by vote in 1973…Narcissistic Personality Disorder was voted out in 1968 and voted back in 1980; where did it go for 12 years? Doctors don’t vote on whether pneumonia is a disease.

The new DSM-5, with its modernized Arabic number, is 947 pages. It contains, along with serious mental illnesses, “binge-eating disorder” (whose symptoms include “eating when not feeling physically hungry”), “caffeine intoxication,” “parent-child relational problem” and my favorite, “antidepressant discontinuation syndrome.” Now psychiatrists can treat the symptoms of going off antidepressants, which is good because the expanded criteria for many disorders allows doctors to prescribe antidepressants more often for more problems. Gone is the “bereavement exemption,” for example. You used to get two weeks after a loved one died before you could be diagnosed with major depression and medicated. Now you get two minutes.

More at the WSJ.

May 23, 2013 | 14 comments | by

Should Popular People Get More Health Care?

This is from Tyler Cowen:

By now it is well known that hanging out with healthy peers predicts (causes?) good health, and unhealthy peers predict (cause?) bad health, for instance as it applies to weight and diet. So what might that mean?

Is it, therefore, socially optimal to invest scarce health care resources in the most popular people ― considering the external effects on the health of others? Tyler has references and links.

May 20, 2013 | 10 comments | by

Bill Gates: Is No Government Better Than Lousy Government?

I was completely surprised that nobody was funding some of these vaccines. When I first looked at this I thought, well, all the good stuff will have been done. It was mind-blowing me to find things like Rotavirus vaccine were going unfunded. One hundred percent of rich kids were getting it and no poor kids were. So over a quarter million kids a year were dying of Rotavirus-caused diarrhea. You could save those lives for $800 per life. That’s like $20 or $30 per year of life. It’s just ridiculous that an intervention like that isn’t funded.

And I’m really surprised at the variance. Some very poor countries run great vaccination systems and some richer ones run terrible programs. The north of Nigeria has about 30 percent vaccination coverage, and they’re above average in terms of wealth within Africa. You compare that to, say, Somalia, which has absolutely no government at all, and they get about 60 percent vaccine coverage of children. So you have a place literally with no government getting a better vaccine coverage than a place that’s above average wealth.

This is from an interview with Ezra Klein.

May 17, 2013 | 13 comments | by

Sentences I Wish I Hadn’t Read

I recently attended a panel discussion of hospital CEOs and CNOs. Two of the executives were touting how their facilities had just recently “stopped all non-emergent inductions and elective cesareans prior to 36 weeks”. They were so proud of this decision to “do the right thing” but lamented how it had impacted their bottom line. Why did it impact their bottom line? Because they experienced a significant (25%) reduction in NICU days. I wanted to stand up and shout “why would you induce or deliver by cesarean any expectant mother if it is not medically necessary?”

More at The Health Care Blog.

May 06, 2013 | 11 comments | by

Has Obama Changed Course on the War on Drugs? No

This is Richard Posner:

The new (that is, the ostensibly new) strategy gives continued primacy to the “war on drugs,” which best describes the criminal-law and (abroad) paramilitary campaigns against the drug trade. No one thinks these campaigns can eradicate illegal drugs. The realistic-seeming objective is, by increasing expected punishment cost and by taking out of circulation (through imprisonment) those not deterred by the cost, the war on drugs raises the prices of illegal drugs. Yet those prices remain very low. The reason appears to be the very high elasticity of supply of drug dealers. It’s like Karl Marx’s “reserve army of the unemployed”; if there is no dearth of persons willing to be drug dealers at modest wages, the principal effect of law enforcement may be to increase labor turnover, at enormous cost in police and prosecutorial resources and above all in incarceration: half the federal prison population in the United States consists of drug offenders. Some 1.7 million persons who are in prison or jail (state or federal) or on probation or parole (or its federal equivalent, supervised release) are in those situations of confinement or restriction because of drug offenses. No doubt the mere fact that drugs are illegal deters some consumers — but how many relative to the large number of persons who have no interest in consuming mind-altering drugs, legal or illegal?

Gary Becker here.

May 06, 2013 | 11 comments | by

Malpractice Law Is Bad for Your Health

A version of this Health Alert (co-authored by Pamela Villarreal) appeared at Townhall.

One of the worst features of the American health care system is the sorry state of medical malpractice law. Fewer than 2 percent of injured patients ever file a lawsuit. Of those that do, only one in 15 receives compensation. More than half of every dollar goes to cover the cost of litigation, rather than to the injured and their families.

Ironically, the medical malpractice system is inordinately focused on whether someone was at fault when an injury or accident occurs. Of the estimated 187,000 deaths (NCPA estimate based on NEJM and NCBI) and 6 million injuries that occur in hospitals each year, only an estimated one in four are considered negligent (malpractice) — and the actual number is probably much lower than that. Another 30 percent (such as certain types of infections) are judged to be “preventable,” even though no one is guilty of negligence. Almost half of adverse medical events are “acts of God” — no one was at fault and there is no obvious way of preventing them.

Apr 29, 2013 | 34 comments | by

A Warning about Warnings

David Henderson had a perceptive post the other day about California’s Proposition 65, which requires a warning label on any product that contains carcinogens, no matter how small the risk. David’s point: if every product contains a warning label, warnings become irrelevant.

A similar problem occurs in medicine, where doctors and other health professionals are developing “alarm fatigue,” causing them to become desensitized and immune to alarm sounds set off by medical devices used for monitoring and treating patients:

According to the commission, between 85 percent and 99 percent of alarm signals do not require clinical intervention. As a consequence, hospital workers may respond by turning the alarms off, reducing their volume or even changing their settings to a level deemed unsafe for patients. Thus, those suffering from alarm fatigue may potentially ignore real emergencies — a circumstance that could have very real implications for patients.

Source: Kaiser Health News.

Apr 19, 2013 | 10 comments | by

Hospitals Game the System

One hospital group encouraged its docs to exaggerate the severity of patient conditions and needlessly admit patients from the ER to hospital beds in order to bill more for their treatment. Another hospital group that owns three hospitals and also partially owns an ambulance company was making patient transfers (using their own ambulance company despite slower response times) a top priority — to the extent that a doctor’s transfer rate was a factor in bonuses and performance reviews. An admin email stated that “the performance we are looking for are transfers.”

This is from Roy M. Poses.

Apr 11, 2013 | 14 comments | by

Does Decreased Length of Hospital Stay Equal Lower Cost?

Based on a 20 percent sample of Medicare claims from 1985-2005 for people 65 and older, Brauer et al. 2009 provide data on length of hospital stay for people with hip fractures in the U.S.

The median length of stay for hip fracture over the period decreased from 12 days to 5 days. Risk-adjusted mortality at 30, 180, and 360 days improved for both men and women:

Men vs. Women

Source: Carmen A. Brauer et al. 2009. “Incidence and Mortality of Hip Fracture in the United States,” JAMA, 302, 14, 1573-1579.

Innumerable studies in the health care literature use reduction of days in hospital as a measure of reduced costs. Unfortunately, the simple reduction of days in hospital and death rates, while welcome, tells us little about readmissions, total costs, or extent of recovery.

With the passage of DRG reimbursement in 1983, hospitals began adjusting their business models to accommodate flat rate payments. One outcome was “quicker but sicker” discharges. In 1986-88, the paper notes that 34.3 percent of hip fracture patients went home with self-care and 33 percent were discharged into skilled nursing facilities. By 2003-05, only 5.3 percent of patients were discharged home with self-care. The majority, 52.9 percent, were discharged to a skilled nursing facility.

Apr 09, 2013 | 8 comments | by

The Market for Second Opinions

ConsultingMD, a new second-opinion firm, offers access to otherwise unreachable, top-class doctors. It signs up medical luminaries by invitation only, making them remotely available to individuals and corporate clients. “Now, a doctor at home on a weekend,” Dr. Hofmann says, “can lend his expertise and be a ‘hero’ to a patient in San Diego, with a nearly real-time turnaround.” Say 72 hours, not two months…

In an estimated 60% of cases, an alternate treatment is recommended — often one that’s more conservative and cheaper. At ConsultingMD, 6 out of 10 cases reviewed by doctors had been misdiagnosed or mistreated. At the Elizabeth Wende Breast Clinic in New York State, second opinions led to the cancellation of 73% of 1,053 surgeries in favor of less-invasive options.

The Wall Street Journal. HT: Jason Shafrin.

Apr 01, 2013 | 11 comments | by
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