More Health Care Equals Better Health. Wanna Bet?

Quiz:

You are 80 years old and have two years to live.  Which hospital would you prefer, Bellvue (large NYC public hospital) or Columbia-Presbyterian (NYC academic private hospital)? 

I assume that most who know these hospitals would jump at Columbia-Presbyterian.  I think that is a safe assumption, but…(you knew it was coming)

I was listening to the Brian Lehrer show on WNYC (NPR) and was fortunate enough to listen to an interview discussing Consumer Reports findings (based on Dartmouth Atlas of Health Care 2008) in which consumer reports says that, especially at end of life (data comes from Medicare), more aggressive health care leads to worse outcomes.  Too many pricks, tests, procedures, hospital acquired infections, extensive recoveries, pharmaceutical mix-ups, etc.  Exposure to more health care can be bad for you. Sometimes conservative health care is better.  Sometimes the primary care physician is better than the specialist.  Sometimes the neighborhood hospital is better than the state-of-the-art hospital.  Bigger is not always better – a lesson Americans are slow to grasp.  SUV’s are not necessarily better than compact cars.  The 6,000 square foot mansion is not necessarily better than the 1,000 square foot apartment. The truth is that the private hospitals have perverse incentives to do more – to the point of harm.  The public hospitals might have incentives to do less.  Both extremes can be to the detriment of the patient.

Most health economics and policy makers grant that health care resources have diminishing returns the more you receive.  Meaning the first few interventions will have dramatic effects, but each additional resource used will have less and less impact until the care actually becomes harmful. Some patients reach that point in some of our hospitals. 

Overuse reaches the point where some states, hospitals, cities use 3x more health care resources than others with unmeasurable effects.  Why?  Because more is not always better, just richer. Health care needs to be smarter. Cars need to be smarter. We need to be smarter. However, getting back to the quiz…

With all that said I would still choose Columbia-Presbyterian, however, I would ask the questions to determine if the care proposed is really going to be good for me.   

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6 responses to “More Health Care Equals Better Health. Wanna Bet?

  1. A 1000 sq foot apt? That sounds great! But that’s another post for another time!

    This is very interesting. As you say, more is not always better. I just never thought to couple that idiom with healthcare but it makes sense.

  2. I don’t have a 1,000 square feet either, but for those reading outside of the 5 boroughs it seemed more realistic.

  3. Wow–would not have expected this… guess that makes me extra American. 😦

  4. This makes sense to me, especially in the context of childbirth and medical care, where interventions often lead to more interventions in a cascade effect ending in unnecessary C-section (cf my comment on the last post). Part of what underlies might be a perspective on the human body as machine/object (when it’s broke, you gotta get in there and muck around to fix it) rather than as dynamic organism (with capacity to heal itself). Laura’s recent post is interesting considered from this angle–a glimpse at where this perspective on the body + current medical technologies can take you…

  5. JTB,

    I definitely agree with you. Medicine often does not take a wholistic view (it may be getiing better), but you have to also consider the economics to do more. The facts are that doctors and hospitals under most payment schemes get paid more to do more regardless of its value or outcome.

  6. Here is a link to Laura’s post referenced above. It’s worth a read:
    http://hoythappenings.wordpress.com/2008/06/03/my-amazing-body/.

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