Here is part of the problem behind health care cost control, from the Annals of Internal Medicine:
Under conditions of constrained resources, cost-saving innovations may improve overall outcomes, even when they are slightly less effective than available options, by permitting more efficient reallocation of resources. The authors systematically reviewed all MEDLINE-cited cost–utility analyses written in English from 2002 to 2007 to identify and describe cost- and quality-decreasing medical innovations that might offer favorable “decrementally” cost-effective tradeoffs–defined as saving at least $100 000 per quality-adjusted life-year lost. Of 2128 cost-effectiveness ratios from 887 publications, only 9 comparisons (0.4% of total) described 8 innovations that were deemed to be decrementally cost-effective. Examples included percutaneous coronary intervention (instead of coronary artery bypass graft) for multivessel coronary disease, repetitive transcranial magnetic stimulation (instead of electroconvulsive therapy) for drug-resistant major depression, watchful waiting for inguinal hernias, and hemodialyzer sterilization and reuse. On a per-patient basis, these innovations yielded savings from $122 to almost $12 000 but losses of 0.001 to 0.021 quality-adjusted life-years (approximately 8 hours to 1 week). These findings demonstrate the rarity of decrementally cost-effective innovations in the medical literature.
Let me just repeat that last sentence: "These findings demonstrate the rarity of decrementally cost-effective innovations in the medical literature."
Even I get tired of saying it, but who controls the research funding?
I wasted like $12000 by not doing watchful waiting on a hernia this year, and now I have to deal with the annoying gut and hip nerve stuff from the surgery.
The curse of the pedant: “criterion” and the addition of a normative prescription in the conclusion.
Chris,
Thanks for the translation.
This is a misleading analysis.
So you understand, this covers cost effective changes in a 6-8 year period. It covers only the delta. It does not cover what was known before about reducing healthcare costs, and assumes those common practices had been implemented. Big money to be made their. It also covers only what is the literature on that subject…but it doesn’t cover, for example, the prescription of a more costly drug over an equally effective drug. it doesn’t cover personnel allocation in hospitals, executive salaries, payments to docs for medical “training and seminars”, doctor ownership of joint venture facilities and resulting overcharges, etc.
Chris,
Beautiful rewrite. What do you do for a living?
Best,
David
This study points to the value of sending our sick, our wounded, our ageing masses yearning to be treated and cured to Mexico, Costa Rica, Brazil, Thailand and India, where the can be more cheaply treated with yesterday’s medicine.
I believe that it all depends on what you want more. For things like Coronary By-pass surgery, I would rather have more quality and time than have more money. Yet all things have in someway or another boiled down to money. In other words you must choose whichever procedure that would give you the most utility for you money, or how much satisfaction that each choice gives you. This question have a very normative element because of its value judgment on time compared to the cost. The real answer comes down to the heart of economics,choice, and it is up to us to make the best choice that we can.
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