This is David Henderson quoting Richard Thaler:
Pharmacists must be the most underemployed professionals. Lots of schooling to count pills. In France they actually do stuff.
David adds:
Milton Friedman … almost single-handedly, in the economics profession [the other one was the late Reuben Kessel] got the case against health-care licensing treated seriously with his chapter on it in Capitalism and Freedom.
Economists’ poll on health care licensing.
One of the consequences of Roemer’s Law has been the idea of “provider induced demand,” and the general notion that everything that happens in health care is because some greedy doctor has deemed it. This means that patients don’t count. What patients may want is irrelevant.
Nowhere is this better illustrated than in Jack Wennberg’s early work on “small area variation” in medical practice.
I was working in the research department at Blue Cross Blue Shield of Maine from 1979 to 1984 and we offered the use of our claims files for his research. He had already done some work in Vermont looking at variations in the rate of tonsillectomies in various towns. He found that in some places physicians surgically remove tonsils at a much greater rate than they do in other places. He concluded that this was an example of Roemer’s Law in effect — scalpel-happy physicians were too quick to order up surgery in some places, but not in others.
We examined the effects in 260 hospitals of a pay-for-performance demonstration project carried out by the Centers for Medicare and Medicaid Services in partnership with Premier Inc., a nationwide hospital system. We compared these results to those of a control group of 780 hospitals not in the demonstration project. The performance of the hospitals in the project initially improved more than the performance of the control group: More than half of the pay-for-performance hospitals achieved high performance scores, compared to fewer than a third of the control hospitals. However, after five years, the two groups’ scores were virtually identical.
See full Health Affairs study.
More evidence that EMRs are not improving the quality of care.
Medicare Chief Actuary: Claims that ObamaCare will reduce medical costs are “false, more than true.”
Another disappointing study result: Pay for Performance doesn’t work.
Bad news for ObamaCare. Pay-for-performance is Massachusetts isn’t working.
More bad news: making preventive care free leads to more utilization. State mandates increased mammograms by 800,000 over 14 years.
What health care rationing will really be like. Very funny video.
Prime Minister: National Health Service is “second rate.” Apparent gaffe.
Very funny explanation of medical loss ratios. (video)
Two more videos on ObamaCare and concierge medicine: Here and here. (HT to Ralph Webber)
This is from a study by Helmchen and Lo Sasso via Austin Frakt:
Using a four-year [2003-2006] sample of 59 physicians and 1.1 million encounters, we study how physicians at a network of primary care clinics responded when their salaried compensation plan was replaced with a lower salary plus substantial piece rates for encounters and select procedures. Although patient characteristics remained unchanged, physicians increased encounters by 11 to 61%, both by increasing encounters per day and days worked at the network, and increased procedures to the maximum reimbursable level.
The extra payment that so dramatically increased encounters was $5 for each reported performance of an eligible procedure.
Based on numerous studies reviewed here, pay for performance and public reporting benefit third parties but put patients at risk. Compliance with “best practice” standards does not improve patient outcomes. Adverse effects include physician avoidance of high-risk patients and system gaming by physicians and hospitals. These effects have a disproportionate effect on patients in minority and lower socioeconomic groups. Administrative and claims source data used in such programs are often inaccurate and invalid. Risk-adjustment methods are not adequate to fully account for the complex features of the highly variable patient population in the United States…
While the AMA has promulgated stringent Principles and Guidelines on PFP, these are often forgotten or blatantly ignored as third-party payers (employers, health insurers, and government regulators) feel increasing pressure to do whatever they can to control their escalating costs.
Full report by David McKalip in the Journal of American Physicians and Surgeons.
$19,911 is the wage gap between college graduates and those with no college. But does the college make the student or does the student make the college?
One more study showing Pay for Performance (the Administration’s only real suggestion for controlling costs) doesn’t work. (Gated but with abstract.)
Two-thirds of Americans take dietary supplements, but what’s in them? They cause 9% of liver injuries.
Can a stomach staple affect the obesity of your future children? Apparently, yes.
Some really neat weather photos. (The subjects could be hazardous to your health.)
Some other neat photos. (Non-hazardous.)
Not necessarily. As we have observed often at this site, pay-for-performance begins with the claim that we should pay more for better outcomes and after sleight-of-the-hand often ends by paying more, not for better outcomes, but for someone's notion of what the correct inputs should be. The latest depressing example is in the field of bariatric surgery ( e.g., stomach staples ):
The notion of designating bariatric surgery centers of excellence was promoted by the Centers for Medicare and Medicaid Services in 2006. The American College of Surgeons and the American Society for Metabolic and Bariatric Surgery established guidelines to designate them.
[However,] patients undergoing bariatric surgery have similar outcomes whether the operation occurs at a so-called "center of excellence" or in a regular hospital, researchers found.
The researchers said the findings show that the government's minimum volume for designation as a center of excellence — 125 operations per year — "does not necessarily result in better outcomes and that the minimum volume requirement is not evidenced-based."
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